Cardiology Coding Alert

Find out if you can report cardioversion separately

If you've got questions about coding critical care, then here are the answers to three of the most common.

Question 1: Is cardioversion separately reportable?

If your cardiologist sees a patient who goes into cardiac arrest, you can still separately report the cardioversion (92960, Cardioversion, elective, electrical, conversion of arrhythmia, external) in addition to critical care. Just remember to attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the critical care code (99291-99292), says Erin Forbes, medical billing specialist at Inlet Cardiopulmonary and Associates in Pawleys Island, S.C. Also, you'll want to link a separate diagnosis for the cardioversion.

Important: Your cardiologist should "carve out" the amount of time he or she spends providing the cardioversion service (or other separately reportable services) from the amount of time you'll report as critical care time, stresses Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition in Mathews, N.C. For instance, if the doctor spends 10 minutes providing services that are separately reimbursed, that time should not be "double billed" as critical care time. "This creates a bit of a documentation challenge for the physician who is typically worried about more important things than documentation," Collins adds.

Keep in mind: Some payers, however, consider defibrillation procedures an integral part of critical care services and thus will not pay for them separately. Check with your local carrier.

Question 2: Can I code for two cardiologists seeing the same critical patient?

Although Medicare allows only one cardiologist to report critical care for any given hour, a second cardiologist can report a subsequent hospital care code (99231-99233) if he also provides care to a critically ill or injured patient. More than one cardiologist can provide critical care services to a patient on the same day if the cardiologist meets the requirement for critical care services--they just can't provide critical care during the same hour.

Question 3: What if my cardiologist sees the same patient twice on the same day?

In this situation, as long as your cardiologist documents critical care in both sessions, you should roll all the time during that day (both sessions) into a total critical care time. For example, if the cardiologist sees a patient at 10:00 a.m. and provides (and documents) one hour of critical care, then sees the patient again at 2:00 p.m. and provides a second hour, then you should report 99291 and two units of +99292.

Additionally, if your doctor sees a patient at one point in the day, provides a separately reportable E/M service, and then has to spend critical care time with the patient later on, you can report both services--such as subsequent hospital care 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient ) and the appropriate critical care code(s), Collins says.