Cardiology Coding Alert

Although routine evaluations are considered part of heart catheterizations, certain E/M services performed before the procedure may be billed separately. Usually, E/M services, such as history and physical (H&P), performed before a heart catheterization would be considered part of the procedure. But if the catheterization is unplanned, reporting an E/M service separately may be appropriate. When the H&P Is Separately Billable Under certain conditions, cardiologists may report taking a patient's history and physical before performing a heart catheterization. For example, a male patient arrives in the hospital emergency room with chest pain. A cardiologist examines the patient and admits him after determining he is having a myocardial infarction and needs a cardiac catheterization. When reporting this scenario, you should bill the heart catheterization as appropriate, and you also may charge for a suitable hospital admission code (e.g., 99223, Initial hospital care, per day, for the evaluation and management of a patient ). You should append the inpatient E/M code with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Although the signs or symptoms (in this case, chest pain) prompted the heart catheterization, "the evaluation of the problem to determine the need for the procedure is considered separately identifiable from the performance of the catheterization, and the cardiologist clearly performed 'significant' E/M services that should be reimbursed," says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.

"Because the procedure was not planned in advance, the required H&P must also be documented during the admission process. Since this is combined with the documentation for the evaluation of the patient's problem, it is not considered a bundled service," Callaway maintains. On the other hand, if the patient had been seeing the cardiologist for palpitations, intermittent chest pain and shortness of breath and the doctor performs an H&P in his or her office and determines a heart catheterization should be scheduled, that procedure will be considered elective, i.e., planned. Any further routine H&P performed on the day of the catheterization (including an evaluation performed because of hospital admission guidelines) cannot be reported separately because it is considered part of the procedure. Of course, the original H&P performed in the cardiologist's office should be billed as an outpatient office visit (99201-99215). Because the office visit preceded the heart catheterization and took place on a different day, you should not use modifier -25. Answering a few key questions is a simple way to determine if the H&P is billable:

1. Was the procedure scheduled from the office? 2. Did you see the patient and determine that a procedure was needed from that initial or established [...]