Cardiology Coding Alert

Bonus: Learn 2 E/M pitfalls that could clog up claims You may not always have instances when your cardiologist performs an E/M service separately from a stress test, but you should know what to do when she does -- or forfeit reimbursement your practice rightly deserves. For example, your cardiologist may need to urgently evaluate a patient following a stress test to determine whether the patient's condition requires more care or discharge. But can you report this? Bottom line: You can report both services, but you need to make certain the E/M visit is separately identifiable from the stress test, says Tammy Anderson, CPC, supervisor of claims at Managed Care Systems in Bakersfield, Calif. Follow these steps, and your stress tests and E/M services will sail through. Step 1: Simply the Stress Portion When you report a stress test, you'll use 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report), if performed in the office, for the global service. If your cardiologist reports only components of the global service, you'll report 93016 (...physician supervision only, without interpretation and report) or 93018 (... interpretation and report only), if performed in the hospital. Red flag: Be aware of the locations that are specific to these codes. You'll report 93016 and 93018 when your cardiologist performs the test in the hospital. If the test takes place in the office, you'll report 93015. Step 2: Watch Out for E/M Pitfalls When you report an E/M service separately, you've got to be wary of two pitfalls. Pitfall 1: In many circumstances, the diagnosis code you report for the E/M service may be the same as the diagnosis code you use for the stress test. "This is the only problem we have," says Connie Cofer, CPC, CIC, a coder at NE George Heart Center in Gainesville, Fla. Payers may question whether the E/M service was truly significant and separately identifiable. Regardless of payer suspicions, you should assign the most accurate codes for all claims. See Step 3 below to find out what you can do to help these claims succeed.

Pitfall 2: If, at the time of the stress test, the cardiologist merely reviews the patient's current status for the sole purpose of verifying that the patient is physically stable to undergo the stress test, you should consider that review as part of the test and not report a separate office visit. Step 3: Weigh in on Modifier 25 You may be wondering if you should attach modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to your significant [...]