Cardiology Coding Alert

Cardiologists can bill for discharges performed after left heart catheterizations only if the discharge occurred on the next calendar day. The precise code to be billed may differ depending on the place of service reported by the cardiologist (inpatient or outpatient) and the status given to the patient by the hospital (inpatient, outpatient or observation). Therefore, practice coders need to communicate with their hospital counterparts to find out how the hospital classified the patient.
 
Evaluation and management services provided on the same calendar day are included in the heart cath unless they are performed for a significant, separately identifiable reason and modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is appended to the appropriate E/M code. In some cases, when a patient has a heart cath, he or she could stay past midnight. Because heart caths have a 0-day global period, any E/M service provided on the next calendar day should be separately payable.
 
Choosing the correct code can be difficult. "It all depends on how the hospital defined the service," says Kathy Mueller, RN, CPC, CCS-P, a general-surgery coding and reimbursement specialist in Lenzburg, Ill. "Hospitals do not all follow the same protocols in these matters. Some hospitals consider heart caths as outpatient procedures, whereas others classify them as inpatient or observation." The hospital's classification of the service is important because different codes may be used depending on whether the service is considered outpatient, observation or inpatient. For example, if the patient is discharged on the same day as the heart cath, no E/M service should be billed because it would be included in the heart cath.
 
If the hospital assigns observation status to the heart-cath patient, it may be possible to bill 99217 (observation care discharge day management) if the discharge occurs on the next calendar day. If the heart-cath patient has inpatient status and is discharged on the next calendar day, use 99238 (hospital discharge day management; 30 minutes or less) or 99239 (... more than 30 minutes).
 
Note: Some hospitals automatically classify a patient as inpatient if an intervention, i.e., angioplasty, stent, atherectomy, is also performed.
 
If the hospital considers cardiac catheterization as an outpatient (but not an observation) procedure, use the appropriate code for an established patient visit (99211-99215) because CPT does not include a separate code for outpatient discharges.
 
To bill successfully in such cases, the cardiologist must also indicate the place of service, using Box 24B on the CMS 1500 claim form. For example, if the patient was admitted as an inpatient, code 21 should be entered. If the service is performed on an outpatient basis, the correct code is 22. [...]