Cardiology Coding Alert

Cardiologists and electrophysiologists may perform tilt-table testing to evaluate patients with syncope (780.2) and other diagnoses. The test, which is typically performed in a cath or EP laboratory, changes the patient's position from 0 to 60 degrees in fewer than 10 seconds. During that time, they monitor the patient's blood pressure and pulse, and observe if syncope (fainting) occurs. The response of the patient's heart rate and blood pressure to the tilting while strapped to a table may disclose the cause of fainting spells. Although there is only one code for the tilt-table testing performed by cardiologists and EP physicians 93660 (Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention) reporting this procedure can still be tricky, says Savanna Siens, CPC, CCS-P, a cardiology coding and reimbursement specialist in Kansas City, Mo.

Cardiologists frequently question the following:

Covered Diagnoses. Most carriers Medicare and private cover tilt-table testing, but for one diagnosis only: syncope (780.2). However, WPS, the Medicare Part B carrier in Illinois, Michigan, Minnesota and Wisconsin, covers the service for several other diagnoses, including:     337.0 Idiopathic peripheral autonomic neuropathy     337.1 Peripheral autonomic neuropathy in disorders classified elsewhere     352.3 Disorders of pneumogastric (10th) nerve; (disorders of vagal nerve)     458.0 Orthostatic hypotension     458.1 Chronic hypotension     458.8 Other specified hypotension     458.9 Hypotension, unspecified     780.4 Dizziness and giddiness.   The cardiologist's documentation should clearly indicate the medical necessity for the test.   Supervision Guidelines. According to Medicare guidelines, tilt tables require the highest level of supervision personal if the procedure is performed in the cardiologist's office by allied healthcare personnel, including registered nurses. This level of supervision is required because the nature of the test is to make the person unconscious, so the cardiologist's presence is required to revive the patient.   The guidelines do not apply to physician assistants, nurse practitioners and clinical nurse specialists, who require only general supervision for the diagnostic tests listed in the memo, including tilt-table testing, says Michael Powe, director of reimbursement with the American Academy of Physician Assistants in Bethesda, Md. Note: The American College of Cardiology recommends that an experienced nurse or laboratory technician be present with a physician in attendance or immediately available.   Professional and Technical Components. Code 93660 can be split into its two components. If the cardiologist does not own the tilt-table equipment, 93660 should be reported with modifier -26 (Professional component) appended, Siens says. (The facility reports the technical component.)

If, on the other hand, the cardiologist or her practice [...]