Cardiology Coding Alert

Question: What diagnosis code would you suggest for an ECG 93000 performed to obtain a baseline on severely disturbed children taking potent psych medications? They present with no cardiac symptoms. Also, which diagnosis code should be used in conjunction with an echo coded 93307, 93320 and 93325 to evaluate valve function for cancer patients after completing chemotherapy or before beginning the next round? They often have no cardiac symptoms (murmur, SOB, etc.) In a perfect world, our physicians will not find disease. What do we code then? Neither investigational drugs nor protocols are being used. I realize your recommendations may not be payable codes, but I need the correct codes to support any appeals. By the way, this is a university teaching hospital; we bill both pro fees and facility fees.

Anonymous California Subscriber

Answer: The ICD-9 code V58.69 (long-term [current] use of other medications) may be used for monitoring high-risk medications such as those described by the reader, says Susan Callaway-Stradley, CPC, CCS-P, a coding consultant and educator in North Augusta, SC, adding that some carriers also want to see, as a secondary diagnosis, the reasons why the child is on the medication. There also is a V-code for chemotherapy (V58.1), but as the reader indicated, there is little likelihood that the echoes will be reimbursed because they are being performed for screening purposes. In this case, that is not an issue because even though screening tests are not covered by Medicare, this is a pediatric service and may be covered by private payers.

The cardiologist should inform the patient that the service probably is not covered and have the patient sign a waiver of liability Advance Beneficiary Notice (ABN), which informs patients that they will be expected to pay for the procedure. If the ABN is not signed, the service cannot be billed to the patient.