Cardiology Coding Alert

Hint:  Only apply modifier 25 when your cardiologist performs minor procedures

When a patient presents for an in-office diagnostic test and your cardiologist provides an evaluation, you'll need to know two important aspects to code the test and office visit correctly:

1. whether your cardiologist already scheduled the test
2. the nature of your cardiologist's pre- and post-test work. To make sure your providers receive their fair share for in-office testing services, our experts say you should implement these three rules of thumb: 1. Bill the E/M with the test if the patient receives an unscheduled test in the office on the same day as the visit. If the cardiologist decides to perform a diagnostic test, such as an echocardiogram or a nuclear study, on the same day as the office visit, you should report both the appropriate diagnostic test code and the office visit code. You should also append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code. Appending modifier 25 will tell payers that the E/M service is separate from the usual patient evaluation that is necessary before, during and after the diagnostic test.
 
Same-day test example: An established patient comes in complaining of palpitations (785.1) and light-headedness (780.4). The provider performs a complete cardiac workup and orders a same-day, in-office echocardiogram.

To report the visit, bill the echo as 93307 (Echocardiography, transthoracic, real-time with image documentation [2D] with or without M-mode recording; complete). You may need to add additional codes, depending on the equipment and the images the physician obtained. These additional codes could include +93320 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display; complete [list separately in addition to codes for echocardiographic imaging]) or +93325 (Doppler echocardiography color flow velocity mapping [list separately in addition to codes for echocardiography]).

Report the office visit with an E/M code, such as 99214 (the level would depend on the physician's documentation), and append modifier 25, says April Leaver, CPC, patient account manager at Morristown Cardiology Associates PA in New Jersey.

"You should add modifier 25 to the E/M code because the patient came in for a specific illness reason and the cardiologist ordered the echo as a result of the exam," says Karen Dearduff, CPC, coding specialist at the Saint Joseph Physician Network in Mishawaka, Ind.

Heads up: "In the past, I didn't use modifier 25 when I reported ancillary codes from the medicine section in addition to an E/M code, but more and more companies are denying your claims if you don't," says Kimberly Engel, CPC, coding coordinator at Advanced Healthcare SC in Germanton, Wis. 2. When the office visit is [...]