Learn These Coronary Blood Flow Measurement 'Slang Terms'
Published on Sun Jun 17, 2007
The 2007 physician fee schedule raises your 93571-93572 reimbursement dollars If your cardiologist takes coronary blood flow measurements during coronary angiograms or cardiac catheterizations and you're not separately reporting it, you could be letting extra reimbursement slip away.
Did you know? The 2007 physician fee schedule raised the average payment for +93571 (Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement ... initial vessel) by 7.4 percent to $99.29, and the payment for +93572 (... each additional vessel) rose 6.8 percent to $77.31. But this good news won't mean much if you're missing out on ethical opportunities to bill these codes. Tackle This Terminology What happens: When a cardiologist takes a coronary blood flow measurement, he measures the difference in blood flow when the patient is resting and then when the patient is at pharmacologic exercise, which simulates physical exercise.
In a normal patient, those coronary arteries will expand considerably to make a larger-caliber vessel. This allows more blood to flow from the aorta into the heart muscle so more oxygen and more nutrients are going to the heart muscle itself. If the patient has a ring of plaque inside of the coronary artery, that plaque ring won't allow that area of vessel to open up.
Thus, the cardiologist will go in and measure the amount of blood flowing through an area of stenosis when the patient is resting and then she will induce pharmacologic stress by injecting adenosine. That should trigger an immediate increase in the blood flow going through the artery, and by measuring how much the blood flow increases, the cardiologist can determine how much the blocked area has affected the patient.
What to look for: Physicians use various techniques that you can bill for using 93571-93572. Look for "slang terms" such as "pressure wire," "coronary flow reserve," "fractional flow reserve study" or "Doppler ultra-sonography" in your documentation. These all refer to a scan for coronary blood flow.
You can look for clues in your physician's documentation that he measured the coronary blood flow, says Cheryl Klarkowski, coding specialist with Baycare Health Systems in Green Bay, Wis. She keeps a list of the "slang terms" for coronary blood flow measurement in her CPT book next to 93571. CMS Regularly Updates Primary Procedures Get this: In the past, Medicare would pay for 93571-93572 only if the doctor repaired a coronary lesion in addition to scanning it. But since 2001, Medicare will pay for 93571-93572 with a coronary angiogram or cardiac catheterization, too.
Medicare regularly updates the list of "primary procedures" you can bill 93571-93572 with, Klarkowski says. You should keep a list of primary procedures for these codes.
"The payable list has changed since I originally started coding the flow wire," [...]
