Cardiology Coding Alert

Get to know your carrier's LCDs You can't always count on CPT guidelines to tell you how to code for the numerous payers you deal with every day. These surefire tips will keep you organized so you can choose the right cardio code and modifier every time.

Scenario: If both your cardiologist and your electrophysiologist see a patient on the same date for an E/M service, you may find out that your Medicare and commercial carriers differ on whether you should use modifier 77 (Repeat procedure by another physician), says Anne Karl, RHIA, CCS-P, CPC, coding and compliance specialist at St. Paul Heart Clinic in Mendota Heights, Minn.

Don't just try-and-fail submitting modifier 77 in this situation. Here's how to keep straight who wants what every time: 1. Chart Those Choices Best bet: Set up a spreadsheet to keep track of frequently applicable payer policies and quirky filing requirements (such as whether carriers prefer you to use modifier 77 or not). In this spreadsheet, you should also note which codes each payer accepts for common procedures, which codes they never accept, which diagnosis codes they allow for each procedure code, which modifiers the payer allows, and how you should report them. Keeping a spreadsheet means that you've got who wants what already ironed out.

"We have a notebook divided by payer with specifics for each. We use this information for discussions with providers," says Nancy Lynn Reading, RN, BS, CPC, a coding educator with University Medical Billing at the University of Utah in Draper.

Example: Along the same lines as the modifier 77 example, you may have one payer that wants you to place "2" in the units box if you use modifier 50 (Bilateral procedure) and another who asks you to place a "1" in the units box for that modifier, and you should make sure this information is at hand in your spreadsheet. 2. Don't Let Your Guard Down To stay current on your payers' policies, you have to dig through their newsletters and Web sites. For instance, you may find a statement about how to report same-day E/M services for cardiologists and electrophysiologists using modifier 77. Because CMS has made a point of going paperless, you have to be doubly vigilant in checking for Medicare and Medicaid online bulletins.

Good practice: "I check our major local and national payers' as well as Medicare's newsletters and policies the first week of every month," Karl says. "It's very beneficial to keep up on what new edits may be coming."

What to do: If your patient is covered by TrailBlazer Health in Texas, and you go to this Medicare carrier's Web site (www.trailblazerhealth.com), in the center of the page you'll see a "What's New" column [...]