Cardiology Coding Alert

Learn what to do if a patient transfers for a same-day catheterization When a cardiology patient undergoes a catheterization, you have to step carefully when deciding which  code to use.  Read the following five cath coding problems, keeping in mind whether the interventions are planned or unplanned, and then decide on a solution. Tackle This Transfer Situation Scenario 1: Greenwich Hospital in Greenwich, Conn., sometimes has to send patients to its affiliate, Yale New Haven Medical Center, for cardiology interventions, writes Carl DeRosa with Cardiovascular Services of Greenwich. That's because Greenwich Hospital's Certificate of Need (CON) license with the state doesn't allow it to perform some cardiac interventions in-house, he explains. So Greenwich Hospital performs the initial catheterization on the patient and then sends the patient to Yale New Haven. But payers often won't cover the initial catheterization when the patient receives two catheterizations on the same day, DeRosa says. Greenwich Hospital is also having trouble obtaining payment for E/M services on the same date, even with modifier 25. How should you code this scenario? Evaluate This Elective Intervention Scenario 2: A patient with non-Q wave myocardial infarction transfers from a rural hospital for elective intervention of a mid-LAD critical stenosis diagnosed on diagnostic heart catheterization. The cardiologist performs the PTCA and drug-eluting stent placement in the LAD. How should you code this scenario? Figure Out This Stent Scenario Scenario 3: A patient presents with a history of angina, CAD, and history of CABG to the diagonal, LAD, and obtuse marginal branch. The cardiologist performed a cardiac catheterization two weeks ago, which showed severe diffuse disease of the distal right coronary artery. The cardiologist schedules elective stenting, during which he places a drug-eluting stent on the RC. How should you code this scenario? Try This Unstable Coronary Syndrome Situation Scenario 4: A patient presented a few weeks ago with an unstable coronary syndrome. The patient had undergone diagnostic heart catheterization, stenting of the LAD and stenting of the first diagonal arteries at that time. The patient did well but had a residual 90 percent stenosis in the mid-right coronary artery. The cardiologist advised the patient to schedule an angioplasty and stenting of that particular lesion. The cardiologist performs the PTCA and places drug-eluting stents on the proximal, mid and distal areas of the RC at the time of the second procedure. How should you code this scenario? Secure Your Seldinger Technique Coding Scenario 5: Your cardiologist's op report states he performed a heart catheterization and interventional procedure. He used the Seldinger technique to insert a guiding catheter into the right femoral artery. Here is a section of the op report: "Positioned a guiding catheter into the left main artery where [...]