Cardiology Coding Alert

Hint: Did the cardiologist decide to perform the treatment based on the angiography?

For years, cardiologists have turned to diagnostic angiography before an intervention to investigate problems in a patient's blood vessels. To protect your reimbursement, you need to know what the 2017 CPT^® guidelines say about reporting diagnostic angiography with interventional cardio services. For an extra compliance boost, learn how to ensure your documentation always meets the CPT^® requirements.

Recognize When Not to Report Diagnostic and Therapeutic Codes Together

Knowing whether you can report angiography as a diagnostic service on the same date as an intervention can be complicated. First, you must ask yourself an important question: Did the cardiologist decide to perform the intervention based on the angiography? If the answer is yes, you can consider reporting the angiography as diagnostic.

However, if the cardiologist already planned the intervention, and the angiography simply assisted with performing the intervention, the angiography would not be considered "diagnostic." Therefore, you would not report a diagnostic angiography code for that service.

Check out this summary of what the 2017 CPT^® manual says about coding for coronary services.

There are certain situations where you should never report diagnostic coronary angiography codes (93454-93461) and injection procedure codes (93563-93564) along with therapeutic services (92920-92944), says CPT^®. Don't report diagnostic angiography codes to report these services:

• Procedures already included in the coronary intervention like contrast injections for verification purposes, roadmapping, and/or fluoroscopic guidance
• Vessel measurement for the coronary intervention
• Post-coronary angioplasty/stent/atherectomy angiography, as those services are included in 92920-92944.

Important: Similar CPT^® 2017 guidelines also apply to non-coronary services such as 75710 (Angiography, extremity, unilateral, radiological supervision and interpretation) and G0269 (Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure [e.g., angioseal plug, vascular plug]). Take the time to read the CPT® guidelines to be sure your coding matches the rules.

Master Exceptions for Reporting Diagnostic With Therapeutic Codes

According to the Society for Cardiovascular Angiography and Interventions (SCAI) guidelines, repeating a diagnostic study for most cardiovascular cath lab procedures is not generally considered medically reasonable and necessary, says Ray Cathey, PA, FAAPA, MHS, MHA, CCS-P, CMSCS, CHCI, CHCC, president of Medical Management Dimensions in Stockton,  Calif.

However, adds Cathey, in some cases, you can report diagnostic codes in conjunction with therapeutic codes, if the angiography meets the below requirements as listed in the CPT^® 2017 manual:

•  There is no prior catheter-based coronary angiography study available, the cardiologist performs a full diagnostic study, and the cardiologist bases his decision to intervene on the diagnostic angiography, or
• Although a prior catheter-based angiographic study may be available, the medical documentation shows that:

                   a. The patient's condition, regarding the clinical indication, has changed since the previous study, or
                   b. The study shows insufficient imaging of the patient's anatomy and/or pathology, or
                   c. A clinical change occurs during the procedure that warrants a new evaluation aside from the original focus of the intervention.

Stay tuned: In the next issue, we'll see why you need to think beyond prior "catheter-based" angiography when considering whether you may report a diagnostic angiography on the day of the intervention. The increase in computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) is something you need to consider in your coding policies and your clinical documentation improvement, and we'll offer some tips and tactics for changing with the times.

Consider Bonus Documentation Tips for Physicians

If you need any recommendations for details physicians can include in their documentation so you know you have full support to code a diagnostic angiography on the same day as an intervention, look to the following advice from our experts:

"The physician must document why he is doing the procedure, if any other imaging was performed, and what was performed in detail to get the complete charges," says Jim Pawloski, BS, MSA, CIRCC, R.T. (R)(CV),  interventional radiology technologist/coder at William Beaumont Hospital in Royal Oak, Mich., and coder at Adreima in Phoenix, Ariz.

"If the documentation supports medical necessity..., there shouldn't be an issue, but that documentation, unfortunately, is frequently missing," says Cathey. "It is incumbent on physicians to document that medical necessity clearly and to communicate that there was adequate reason to repeat the diagnostic study to their coding staff."