Cardiology Coding Alert

HInt: The date of service is the day your cardiologist interprets the data

If your cardiologist sends a patient home with an implanted cardiac defibrillator, you may not need to wait until the next visit to check up on his progress, thanks to new technology allowing remote interrogation of defibrillators. Unfortunately, this new technology didn't come with a ready-made coding solution.

Carriers stepping up: Part B carrier Noridian has agreed to cover the new technology that uses services such as Medtronic's CareLink to electronically transmit data to a receiving station, where it is stored until the physician can evaluate it. These devices also can transmit an unexpected event, such as a discharge from the defibrillator or cardiac arrhythmia, Noridian says.

Weigh Your 2 CPT Options

Because this technology is new, you'll find a lot of variance as to how you should code this service. Here are your options:

Option 1: Until there's a more specific CPT code, carriers may want you to use 93741 (Electronic analysis of pacing cardioverter-defibrillator [includes interrogation, evaluation of pulse generator status, evaluation of programmable parameters at rest and during activity where applicable, using electrocardiographic recording and interpretation of recordings at rest and during exercise, analysis of event markers and device response]; single chamber or wearable cardioverter-defibrillator system, without reprogramming) or 93743 (... dual chamber, without reprogramming), says Terri Davis, CPC, CIC, a coding supervisor at The University of Oklahoma College of Medicine in Oklahoma City.

Warning: Avoid codes that include "reprogramming" in their descriptors (such as, 93742 and 93744), because the analysis of an ICD won't include any device reprogramming.

Red flag: Carriers, such as Noridian, also advise coders not to report this service more than three times per 60-day period unless you have a specific medical reason in your documentation.

If the service your cardiologist provides is comparable to the descriptions for 93741 and 93743, you can report it regardless of where the service took place, whether in the office, over the Internet, or over a phone line, says the Heart Rhythm Society (HRS) in the 2005 Coding Guide for Heart Rhythm Procedures. 

Option 2: Some carriers, such as Oklahoma Medicare, prefer another coding route. For remote checks of defibrillators, they may request that you report an unlisted-procedure code - specifically, 93799 (Unlisted cardiovascular service or procedure).

Rule of thumb: Check with your carriers to see which code(s) they prefer. As an alternative, you might ask the device company representative who helps you get set up on the remote monitoring program for documentation from your carrier - that way you won't have to waste time getting OK'd every time you file these claims. 

Get Your Documentation Ducks in Order

When you're filling out the CMS 1500 form for remote ICD interrogation procedures, you'll need to take extra care making sure you appropriately describe the service to your carrier because of this technology's newness. Here are three helpful tips to ensure reimbursement success.

Tip 1: "We use 93799 and then type in 'ICD Internet Interrogation' in Box 19 of the CMS 1500 form," says Martha Tracy, CPC, coding and compliance manager of Mid-America Cardiology in Mission, Kan.

Tip 2: Tracy recommends including the following information as well: