Cardiology Coding Alert

Uncover the truth about coding critical care along with other E/M services What happens to your cardiologist's critical care claims can make or break your reimbursement. Rid your coding practice of these three critical care myths and boost your bottom line. Myth 1: Reporting Critical Codes and EKG Is OK If you think you can report procedures such as EKGs when also reporting critical care codes (as long as you have proper documentation), think again.
 
Key: Critical care codes have exclusions that apply to the physician side, not to facility billing. For example, if your cardiologist performs an EKG while providing critical care, you cannot report both the critical care and the EKG. Actually, only facilities can report those "excluded" procedures, says Andrea Clark, RHIA, CCS, CPC-H, founder and president of Health Revenue Assurance Associates in Florida, who presented on emergency department claims at the Fifth Annual Ingenix Essentials conference.
 
Here's a breakdown of the services critical care codes include, according to CPT:
 
• interpreting cardiac output measurements
 
• chest x-rays
 
• pulse oximetry
 
• blood gases and information stored in computers
 
• gastric intubation
 
• temporary transcutaneous pacing
 
• ventilation management
 
• vascular access procedures. If your cardiologist provides a service not included on this list, you should report it separately from the critical care code. Myth 2: Critical Care and E/M Service? No Way Because critical care constitutes intensive time with the patient, some coders believe that you cannot report an E/M service in addition to critical care. That's not always true.
 
Example: Your cardiologist performs 60 minutes of critical care (99291, Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and then six hours of an extended discharge (99239).

At first glance, you may think you shouldn't report critical care and discharges on the same day. But "it is not uncommon for you to bill a discharge on the day your cardiologist performed critical care because most likely your cardiologist is billing for the death summary and final discharge paperwork," says Inga Burton, ACS-CA, certified coding specialist at Prima Heart Physicians in Tucson, Arizona. "I would add modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) on the discharge code (99239) to justify reporting both the critical care and E/M service." Myth 3: You Can Include the Procedure's Time With Critical Care Time Watch out if you're including time your cardiologist spends on a separately reportable procedure along with critical care time because you could face a costly audit. Here's how you should be carving out a procedure from the critical care time.
 
Example: The patient is hemodynamically unstable. Your cardiologist provides critical care for the patient for one [...]