Cardiology Coding Alert

Question: Can I report a consult for a heart cath done later that same day when the heart cath was done as a planned procedure just prior to AAA repair by another physician?

Codify Member

Answer: Based on the information given, the "consult" in the question is most likely a routine preoperative service that payers may not consider separately payable.

For those payers that follow Medicare rules, recall that heart catheterization services typically have a 0-day global period, which makes it a minor surgery. For instance, you’ll find a 0-day global listed for 93458 (Catheter placement in coronary artery[s] for coronary angiography, including intraprocedural injection[s] for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection[s] for left ventriculography, when performed).

Medicare states, "where the decision to perform the minor procedure is typically done immediately before the service, it is considered a routine preoperative service and a visit or consultation is not billed in addition to the procedure" (Medicare Claims Processing Manual, Chapter 12, Section 40.2.A.4, www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf).

Reminder: The use of the term "consult" raises the question of whether the specific payer accepts consult codes. Medicare and many other payers no longer reimburse consult codes, requiring you to instead use an appropriate E/M code for reportable services.