Cardiology Coding Alert

Heads up: You cannot separately report 93561-93562

When your cardiologist performs critical care for a patient, you should be wary of trying to report services that payers already consider included in the critical care period.

This chart, provided by Debra Ferenc, BS, CPC, CPC-H, CMC, during her presentation "Optimize Reimbursement for Critical Care" at The Coding Institute's recent Cardiology Coding and Reimbursement Conference, breaks down the codes you should avoid trying to report separately.

You should report any services your cardiologist performs separately that are not listed here.

Keep in mind: The National Correct Coding Initiative bundles the procedures listed in the chart above into 99291-99292, but you can use a modifier in a few instances to separate them. For example, if a patient sees a cardiologist for 36000 (Introduction of needle or intracatheter, vein) in the morning and then later in the day needs critical care, you can report 36000 separately using modifier 59 (Distinct procedural service). Be sure to include documentation to show how these services are separate and distinct.

Remember: CMS outlines treatment criteria as requiring "direct personal management" by the physician. To qualify for critical care, you cardiologist must document how the patient has a high probability of sudden, clinically significant or life-threatening deterioration in his condition that requires the highest level of physician preparedness to intervene urgently.

Missed out on this year's conference? To learn about The Coding Institute's 2007 cardiology conferences, go to www.codingconferences.com.