Cardiology Coding Alert

" The 2000 HCPCS manual introduced G0166 (external counterpulsation, per treatment), which cardiologists can report when they provide external counterpulsation (ECP) services to Medicare patients. The situation is difficult when the cardiologist treats a patient with private insurance, in part because CPT does not include a specific code for ECP.
 
In the absence of a specific code, there is much confusion about how to bill for the service. The situation is further complicated because coding recommendations provided by the manufacturer of ECP devices are considered inappropriate by most carriers, says Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan. If an unlisted-procedure code is used and is also well documented, most carriers will pay for the treatment.
Thirty-Five One-Hour Treatments
External counterpulsation is a noninvasive technique used to treat ischemic heart disease. During the treatment, the lower extremities and lower trunk are wrapped in a series of three compressive air cuffs that inflate and deflate in tandem with the patient's cardiac cycle. This reduces the pressure the heart must pump against, increases the rate of return of blood to the heart, and increases blood pressure during the filling phase of the cardiac cycle. These actions, in turn, increase the amount of blood and oxygen going into the coronary arteries and decrease the work of the heart when it beats. 
 
Many patients who undergo these treatments experi-ence increased time until onset of ischemia, increased exercise tolerance and a reduction in the number and severity of anginal episodes. A full course of therapy consists of 35 one- or two-hour treatments, which may be offered once or twice daily, usually five days per week.
 
The components of the procedure include the use of the device, finger plethysmography to follow the blood flow, continuous EKGs to trigger inflation and deflation, and optional use of pulse oximetry to measure oxygen saturation before and after treatment.
 
External counterpulsation is distinguished from intra-aortic balloon counterpulsation, which is a more familiar, invasive form of counterpulsation used as a method of temporary circulatory assistance for the ischemic heart, often after an acute myocardial infarction. Although intra-aortic balloon counterpulsation has its own code (92971, cardioassist method of circulatory assist; external), it does not accurately describe ECP, which is thought to provide a permanent effect on the heart by enhancing coronary collateral circulation.
HCPCS Code G0166
Most Medicare carriers instruct cardiologists to use G0166. When performed in a nonfacility setting, the CMS fee schedule assigns 3.76 CQ relative value units (RVUs) to each treatment, for a total of 131.6 RVUs for 35 treatments, which may be given once or twice daily, typically five days a week. (The fee schedule assigned ECP only 0.11 RVUs if the treatments are [...]