# Cardiology help



## qljade1 (Oct 28, 2009)

Hello all, 

Sorry I havent been to meeting in a while, but i had baby girl 8 months ago (needless to say she's been keeping me busy after work) and that I got a new job. I'm now working for a cardiology practice in Wayne, NJ (1 mile from my house, how nice is that?!). The doctors I work for are the board Doctors for St. Joseph's Hopital in Paterson and in Wayne.  

So I have a few cardiology coding questions that i'd like to put out there if anyone is in the specialty. I thought I remembered some of you were in Cardiolgy.  Just reply to this and then I'll post my questions away. 

Thanks for your help in advance and I am truely trying to make the next meeting. I keep talking about it in my new office.  

Hope all is well with all, 
Stephanie


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## sowmya (Oct 28, 2009)

Hi Stepahnie,

I currently work for a cardiologist in Indiana. I will try my best to help you. Send your queries.

skk


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## jlb102780 (Oct 28, 2009)

Hi, I do the hosptial charges for a group of cardiologist, I'll do my best to try to help answer any questions you have


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## qljade1 (Oct 30, 2009)

OK here are my questions, lets see what we get..........

1. Can you bill an O/V with a pacemaker check on the same day, same Doctor?  

2. If a patient is in a nursing home and brought to the office for a pacemaker check can you bill it?

3. TTM's are billable only once every 90 days.  Can you bill more if there is a problem with it or the patients condition changes?

4. This on is causing a stir in my office, How long after a complete cath can you bill 93508 again?  I'm being told its a red flag for insurance companies.....???? The Doctor is going back in a few weeks later to do a stent and also billing 93508.

5. Should an office visit and cardiodynamics (93701) be billed together with a -25 on the office visit?  

Again, thanks for any help, and any ignorence on my part, Cardiology is new to me.

Stephanie


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## jlb102780 (Nov 2, 2009)

qljade1 said:


> OK here are my questions, lets see what we get..........
> 
> 1. Can you bill an O/V with a pacemaker check on the same day, same Doctor?
> 
> ...



Hi Stephanie

I'm also new to cardio, only been billing this specialty for a year. 
As far as for your question #4. Did the docs document doing the angiography again (93545)? Sometimes my docs will have to go back in a few days later to do a stent to a different artery. In those cases, I only bill for the stent unless they document that they had to repeat the angiography. If they did have to do it, then I bill for it, but add mod 78 if needed. 

Hope that helps you some. Sorry I couldn't be anymore help to your other questions. I only do the hosptial charges for my docs.


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## sowmya (Nov 2, 2009)

Hi Stephanie,

1.you can bill o/v with pacemaker placement with same day add 25 modifier. I haven't recieved any denials so far, but make sure with the new pacemaker codes listed in the front of cpt book.
2. you can bill for pacemaker check in the office for a nursing home resident, make sure you have the order and /or if your MD is not the medical officer for that nursing home then you need the referral from the MD of the nursing home or supervising doc. of pt. in NH.
3.I am not sure.
4. I don't think that there is any rule on how long after. As long as the op report states that right heart cath is done without measuring any lv presuures then you can bill 93508 along with stent adding a 78 modifier.I had not recieved any denials on these also so far. 
5. I am not sure .

I have given my input based on how I had not recieved any denials, but I can be ignorant too. Let's help each other. If you get to know anything different, let me know.
skk


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## deeva456 (Nov 2, 2009)

qljade1 said:


> OK here are my questions, lets see what we get..........
> 
> 1. Can you bill an O/V with a pacemaker check on the same day, same Doctor?
> 
> ...




Hi, congatulations on your new baby!  
here are your answers....

#1: yes, unless the ov is during the 90 global period following the pacemaker then you cannot bill the ov, unless it is for a separate condition/dx not related to the pacemaker implant. 

#2: yes. If your office owns the equipment and the doctor, nurse or employee is doing the pacer check, then you have to split bill the charges. Bill the SNF for the technical portion (TC modifier) and Medicare or other payer for the professional portion (26 modifier).

#3. Yes, if it is medically necessary and supported in your documentation. 

#4. If your doctor is only going back in to place a stent, you cannot bill 93508. Catheter placement is included with the stent. 

#5: You can add modifier 25 but it is not required, some payers will want mod 25;  but most payers do not pay on 93701. 

I hope this has helped!

Dolores, CPC-CCC


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## Jess1125 (Nov 3, 2009)

Regarding #3 I feel that the answer would be no and that the code can only be billed once every 90 days. I have an article from CPT Assistant February 2009 that states, "Another significant change with the new code is the fact that the new code is reported only once per 90-day period. For example, if a patient with a pacemaker is nearing elective battery replacement and warrants frequent device checks, such as weekly, it may be clinically appropriate to perform multiple evaluations within a 90-day period; however only one code can be reported every 90 days". 

Jessica CPC, CCC


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## qljade1 (Nov 4, 2009)

thanks everyone for your help. it was all very informative and helped clear some things up here. well, here's another one....

REMOTE ICD AND PACEMAKER CHECKS:
we are being told by the vendor to bill 93294, 93296.  and 93295,93296.  we are getting all the 93296's denied. the vendor says no modifer needed, but denials say inclusive.  the cci has no edits in the book.

any info would be great. 
thanks
stephanie


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## pboey (Nov 4, 2009)

*Family Practice billing*

I've been asked to help a family practice physician clean up the practice's a/r.  Currently the practice is billing in hard copy.  I'm looking for a professional advice on how to bill the physician for my service in  cleaning up his a/r?  Should I bill hourly, how much? Percentage of monies collected?  I am a certified independent contract coder with 15yrs coding/billing experience.  

Pat CPC


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## Jess1125 (Nov 5, 2009)

Stephanie,

CCI effective for 1/1/09 did have two edits that were a major error which prohibited us from billing 93296 with professional service codes 93294 and 93295. In addition, the edits had a modifier indicator of "0" so a modifier couldn't be used to overide them.

The good news was that effective 4/1/09 CCI retroactively deleted these edits and claims could be resubmitted or appealed that were denied because of these edits. I'm not having issues anymore.

Hope this helps.
Jessica CPC, CCC


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