Cardiology Coding Alert

Discover why a 'shadow audit' could be your salvation   If your arterial stent documentation isn't up to snuff, you should brace yourself for audits.

Bottom line: Coders billed 20 of 72 arterial stent placements in the outpatient setting incorrectly, according to an October 2005 HHS Office of Inspector General report (A-06-04-00091).

Overall problems: The OIG found that many stent records lacked information on medical necessity for thrombectomy with angioplasty and stent placement. Also, the OIG found that providers failed to use the proper code for thrombectomy in some cases. In others, the provider tried to bill separately for thrombolysis and stent placement, when the thrombolysis should have been bundled.

"I'm not surprised that this happens. Often physicians feel that they should bill for all aspects of the procedure they perform" without taking into account National Correct Coding Initiative bundles and code definitions, says Belinda Keeling, CPC, audit and education department coder at Acadiana Computer Systems in Lafayette, La.

You should realize that "thrombectomy code +92973 (Percutaneous transluminal coronary thrombectomy [list separately in addition to code for primary procedure]) is an add-on code," says Yvette Hofmeister, CPC, coding analyst for OSU Internal Medicine in Dublin, Ohio.

You must use 92973 with the following codes, according to CPT:

• 92980--Transcatheter placement of an intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel
• 92982--Percutaneous transluminal coronary balloon angioplasty; single vessel.

"The cardiologist has to be clear as to why this add-on procedure is needed in addition to the stent, because he would perform this in the same vessel," Hofmeister says. In other words, your cardiologist's documentation has to be up to snuff to avoid the mistakes OIG mentioned.   Evade These Documentation Pitfalls   Three cardiology documentation errors could lead to the kind of problems the OIG discovered. Here are the pitfalls you should learn to avoid: 

Pitfall #1: Semi-automated reports. Many cardiologists prefer to use the catheterization lab information system to generate their documentation for procedures, instead of dictating their reports the old-fashioned way, experts say. These semi-automated reports don't explain the reasons why a doctor chose a particular set of interventions. That can lead to incorrect coding. 

"Documenting procedures in this fashion can also be problematic because the author of each entry in the medical record is not clearly recorded," says Jim Collins, CPC, ACS-CA, CHCC, president of The Cardiology Coalition in Matthews, N.C. "These are legal documents, and each entry must be signed and dated by the appropriate author. Automated systems are often driven by cath lab technicians, not the physician."

Pitfall #2: Anatomical misunderstandings. You're not alone if you have difficulty figuring out what constitutes a single coronary artery, but that sort [...]