Get Paid for E/M Services Performed On the Same Day as Heart Catheterization
Published on Sat Jan 01, 2000
Many cardiologists are uncertain about billing evaluation and management (E/M) visits on the same day as a cardiac catheterization. That is not surprising because in some situations, E/M services performed either before or after the procedure may be billed separately, even though routine evaluations are considered part of the service.
Although E/M services such as history and physical (H&P) before a heart cath normally would be considered part of the procedure, it may be appropriate to bill the H&P separately, particularly when the heart cath is unplanned. Similarly, although routine follow-up care also usually is included in the procedure, an unexpected cath may require special attention by the physician, which could be billed separately.
Non-routine Follow-up Care Is Billable
John OMeara, MD, a cardiologist in Portland, Maine, explains, I spend time reviewing cath films, making a decision about what therapy to recommend to the patient (e.g., percutaneous transluminal coronary angioplasty [PTCA], coronary artery bypass graft [CABG]), discussing options with the patient, and then starting a new medication, arranging for subsequent admission for revascularization or even admitting the patient to inpatient unit. OMeara is uncertain, however, whether he can bill an E/M code because everything has been done on the same day.
If the follow up is not what was expected when catheterization was performed, the answer is yes, says Susan Callaway-Stradley, CPC, CCS-P, a coding specialist and educator in North Augusta, S.C. The E/M should be billed at the appropriate level with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). The supporting documentation must indicate that the catheterization results were different from what the cardiologist expected, and that a great deal of time has been spent reworking the patients treatment plan (e.g., the patient may require a bypass operation).
Bill H&P Separately
Under certain conditions, cardiologists also may bill for taking a patients history and physical before a heart catheterization is performed. For example, a male patient arrives in a hospital emergency room with chest pain. He is seen by a cardiologist, who admits him after determining he is having a myocardial infarction and needs a cardiac catheterization.
The cardiologist bills for the heart catheterization as appropriate and also may charge for a 99223 (initial hospital care, per day, for the evaluation and management of a patient, which requires these three components: comprehensive history and examination, and medical decision making of high complexity) with modifier -25 attached. Even though the signs or symptoms (in this case, chest pain) prompted the heart catheterization, they are not considered related, and the cardiologist clearly performed significant E/M services that should be reimbursed.
Because the procedure was not [...]
