Cardiology Coding Alert

Your new code option will change how you calculate units, too.

Cardiologists may use adenosine to treat a patient’s irregular heartbeat or to improve blood flow to the heart during a stress test, and knowing why the patient needed the adenosine was the key to proper coding in 2014. But the new year brought a new way to code. Here are the details.

Old Way: Decipher Intent and Calculate Units

In 2014, you chose the proper adenosine code based on its intended purpose.

Therapeutic: When the provider used the adenosine for therapeutic reasons, you reported J0150 (Injection, adenosine for therapeutic use, 6 mg [not to be used to report any adenosine phosphate compounds, instead use A9270]).

Diagnostic: For diagnostic uses, you reported J0151 (Injection, adenosine for diagnostic use, 1 mg [not to be used to report any adenosine phosphate compounds, instead use A9270]). HCPCS introduced J0151 in 2014 to replace J0152 (Injection, adenosine for diagnostic use, 30 mg [not to be used to report any adenosine phosphate compounds; instead use A9270]).

Units: As the descriptors show, you reported 1 unit of therapeutic code J0150 for each 6 mg. In contrast, you reported 1 unit of diagnostic code J0151 for each 1 mg administered.

New Way: Simplify Coding Using J0153

As of Jan. 1, 2015, you should not report J0150 or J0151. HCPCS 2015 deletes both of those codes.

In their place, HCPCS 2015 adds J0153 (Injection, adenosine, 1 mg [not to be used to report any adenosine phosphate compounds]).

You should report one unit of this new code for every 1 mg used. You may use this code regardless of whether it’s for diagnostic or therapeutic use. The code descriptor does not limit your use of the code based on the intent of the service.

Key point: In 2014, one unit of therapeutic code J0150 represented 6 mg. In 2015, one unit of J0153 represents 1 mg. Be sure to double check your units and cost per unit to avoid underreporting or overcharging of adenosine, says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee. The change to 1 mg per unit should lead to fewer calculation errors in the future, Neighbors adds.

Another difference: The new code, like the old codes, is not appropriate for adenosine phosphate compounds. But there is a small difference. The old codes instructed you to use A9270 (Non-covered item or service) for those compounds. New code J0153 does not point you to a specific code for adenosine phosphate compounds.

2015 example: A patient comes into the office for a stress test. The cardiologist orders use of adenosine because the patient can’t perform the treadmill or bike exercise needed to stress the heart sufficiently for the test. The adenosine mimics the effects of exercise on the heart and dilates the coronary vessels. Documentation shows administration of 73 mg of adenosine. In 2015, you should report the supply of the adenosine with 73 units of J0153. You should report the stress test separately, using an appropriate code such as 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report).