Cardiology Coding Alert

If two cardiologists are providing concurrent care to a patient, the likelihood of both receiving appropriate reimbursement is greater if coders demonstrate that the care the individual physicians give is necessary because of special training or expertise in a subspecialty.

There are two ways to make this information available to the payer, says Jim Collins, CHCC, CPC, a coding consultant and compliance officer with Mid-Carolina Cardiology in Matthews, N.C.

You can submit a paper claim with supporting documentation - a copy of the provider's note and notification that he or she fits into a different subspecialty of cardiology than the other provider, Collins suggests. Even so, this approach may be impractical because you would need a copy of the provider's visit note, and this could take several weeks after a patient is discharged.

With some carriers, the early bird often gets the worm. For example, CIGNA Medicare in North Carolina may pay the first claim received and deny subsequent claims when physicians of the same specialty bill for the same services to the same patient on the same day, Collins says.

A better approach is to indicate your provider's subspe-cialty on the appropriate CMS form (box 19 on CMS-1500), which will help reduce denials and keep your provider in the running in the claims-submission race, Collins says.

Editor's note: To access the CMS 1500 form, go to http://cms.hhs.gov/medicare/edi/cms1500.pdf.