Cardiology Coding Alert

Follow this expert advice on adjusting your documentation to avoid audits

Your chances of attaining adequate reimbursement for 33249 just got better - thanks to Medicare's coverage expansion to nearly 500,000 patients, released Jan. 27.

We've got the scoop on what criteria you must have documentation of to receive your share of the spoils.

Be the Bearer of Good News

The first step to collecting for your physicians' 33249 services is to inform your electrophysiologists (EP) of the details of this new decision.

"Determining whether or not the patient fits the criteria is the physician's responsibility. My responsibility is making sure that the physicians involved know of the criteria," says Rebecca Sanzone, CPC, billing manager for Midatlantic Cardiovascular Associates of Baltimore.

Most likely, cluing in your EPs about the expanded criteria for 33249 (Insertion or repositioning of electrode lead[s] for single- or dual-chamber pacing cardioverter-defibrillator and insertion of pulse generator) will make their day.

Editor's note: You can find the full 46-page Medicare Coverage Decision online at www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=148.

Craft a Clean Claim to Collect

The next step is to be certain that you've got correct coding for the suite of services your cardiologist may perform (in addition to 33249).

If you have the appropriate documentation, make sure to bill for fluoroscopy (71090-26, Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation; professional component) as well as the electrophysiologic test of the defibrillator (93641, Electrophysiologic evaluation of single- or dual-chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation [induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination] at time of initial implantation or replacement; with testing of single- or dual-chamber pacing cardioverter-defibrillator pulse generator). Cardiologists commonly perform these procedures at the same time as an ICD generator implantation.

Keep in mind that Medicare pays two different amounts - one to the hospital and one to the EP, which can be costly.

Note: Medicare will reimburse the doctor who implants the device the same amount regardless of whether the device is single- or dual-chamber.

Medicare's new decision means it will be spending more, so you can expect that your practice may be subject to more audits and prepayment reviews for ICD implantation, but armed with the following knowledge you'll be able to navigate the Medicare coverage maze. You can also get ready for more prepayment reviews by making sure you submit definitive proof of meeting the criteria for coverage.
  
Prepare Your Documentation for the Worst

Strategy: Before your doctors implant defibrillators under this new coverage criteria, make sure they have the necessary documentation. 

"When my practice receives a denial, I usually point out how my EP felt the patient's clinical picture had true impact on the decision to proceed with the device implant when the policy coverage guidelines weren't completely satisfied," says Kathleen Krysiak, RN, BSN, CCM, CCP, a utilization review nurse at Medicore Associates Inc. in Erie, Pa. Often, it is "the previous myocardial infarction (MI) that is the problem."

To avoid this situation, look at your documentation guidelines. Medicare states that your EP should define and document MIs according to the consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction.
 
Editor's note: You can find this information at www.acc.org/clinical/consenses/mi_refined/.

You can also prove that the patient met the requirement for a less-than-or-equal-to-35-percent ejection fraction by submitting the results of: