Cardiology Coding Alert

Question: If a patient comes into the office for an echocardiogram and the doctor performs an exam during the same visit (using the same diagnosis as for the echo), are both services billable? Modifier -25 does not seem appropriate because the examination is not significant and separately identifiable.

Vermont Subscriber

Answer: Even though Medicare has suspended its requirement that modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) be appended to E/M services performed at the same session or on the same date as diagnostic tests (such as echos), the examination must still be significant and separately identifiable, says Terry Fletcher, BS, CPC, CCS-P, CCS, an independent coding and reimbursement specialist in Laguna Beach, Calif. She notes that in some states, such as California, local Medicare carriers continue to require modifier -25 on E/M services performed at the same time as diagnostic tests.

Fletcher also notes that if the patient has been sent to the cardiologist by his or her primary care physician specifically for an echocardiogram, the E/M (an office visit or consult code) would not likely be separately payable unless there was an additional problem that warranted the evaluation.

You cant bill for the E/M unless the cardiologist made the decision to do the echo based on the examination, Fletcher says. Some physicians, however, feel obligated to give test results to the patient or to perform an exam when it was not requested and try to bill a consult code. This does not meet the criteria for a consult. Therefore, only the echo can be billed.