Cardiology Coding Alert

Question: Our cardiologist performed discharge services after he performed a left heart catheterization. How should we bill for the discharge?
      
Missouri Subscriber

Answer: Cardiologists can bill for discharges performed after left heart catheterizations only if the discharge occurred on the next calendar day. The precise code you would bill may differ depending on the place of service the cardiologist reports (inpatient or outpatient) and the status the hospital gives the patient (inpatient, outpatient or observation). Therefore, you should communicate with the hospital to find out how the hospital classified the patient.
 
You include the E/M services the physician provides on the same calendar day in the heart cath unless the services are for a significant, separately identifiable reason, such as high blood pressure. In this case, you would append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate E/M code. Remind your physician to summarize in his notes any care the patient will receive after the heart cath. Doing so will help justify an E/M code following the cath procedure.

In some cases, when a patient has a heart cath, he or she could stay past midnight. Because heart caths have a zero-day global period, any E/M service, such as a discharge, the physician provides on the next calendar day should be separately payable.
  
If the hospital assigns observation status to the heart-cath patient, you could bill 99217 (Observation care discharge day management) if the physician discharges the patient the next calendar day. If the heart-cath patient has inpatient status and the physician discharges him on the next calendar day, use 99238 (Hospital discharge day management; 30 minutes or less) or 99239 (... more than 30 minutes).
 
If the hospital considers cardiac catheterization an outpatient (but not an observation) procedure, use the appropriate code for an established patient visit (99211-99215) because CPT does not include a separate code for outpatient discharges.