Cardiology Coding Alert

 Ask your hospital for its supervision policies to be on the safe side

Avoid getting tripped up on the finer points of reporting CPT 93660 by tackling these three questions --; otherwise, you could be footing the bill for this expensive test.
 
What it is: Tilt-table testing helps the cardiologist diagnose and categorize forms of reflex-mediated syncope (also known as neurally mediated, vasodepressor, neurocardiogenic or vasovagal syncope). Cardiologists should only perform this test after other potentially harmful causes have been ruled out by history, physical examination or other appropriate tests.
 
Watch out: A lack of preliminary evaluation may cause payers to deny your claim.

Set Your Sights on the Setting and Interventions

Question 1: After technicians tilt the patient at 60 to 80 degrees for 30 to 45 minutes, the hospital technicians, as a second-stage approach, administer isoproterenol infusion or sublingual nitroglycerine. Should you bill for the cost or administration of these pharmacological interventions?

 Answer: No. When the patient has a tilt-table test, we do not bill for the cost or administration of any drugs," says Jessica Carriveau, CPC, coder at Cardiology Associates of Green Bay Ltd. in Wisconsin. Why: The tilt-table test code (93660, Evaluation of cardiovascular function with tilt-table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention) includes all aspects of the test in a hospital setting. For example, 93660 includes the ECG and blood pressure monitoring.
 
Catch this: If, however, you administer the test in the cardiologist's outpatient office, you can report the pharmacologic drug provision separately.

Don't Assume When It Comes to Supervision

Question 2: Although coding experts often debate whether the cardiologist must be present during the tilt test procedure because of the low risk to the patient, most carriers require the cardiologist to be physically in attendance or close by should a problem arise. Is this true or false?
 
Answer: True. 
 
Rationale: This could be for liability reasons or hospital policy, says a Missoula, Mont., subscriber and coder for a multi-cardiologist specialty office. The patient's heart rate and blood pressure could bottom out.
 
Some insurers may deny your claim if you don't document the physician's personal supervision, while some payers only require direct supervision. Best advice: You should always confirm your payer's policies in writing before you report any tilt-table testing codes.

Tackle the E/M and Tilt-Table Same-Day Dilemma 

Question 3: You cannot bill a separately payable E/M  on the same day that you report the tilt test unless the physician's documentation supports this separately identifiable service. Is this true or false?
 
Answer: True. If you can show that the E/M was a separate service, you can append modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the E/M code (99201-99215 for outpatient office visits).
 
Example: If a patient presents to your practice for her first visit and the cardiologist performs a tilt-table test later that day, you can report both the E/M code and 93660. Just remember to attach modifier 25 to the E/M code.