Cardiology Coding Alert

Question: We normally report 36415 when patients present for Coumadin treatment, but our cardiologist also calls the patients to discuss the results and tomanage treatment. Can we report any other codes to reflect the detailed nature and time that we spend on this phone call?

Answer: You cannot bill an E/M service when you merely perform a test or convey test findings. CPT does include codes for telephone calls (99371-99373), but  most payers don't cover them.

Cardiology practices should report E/M codes (99201-99215) if they administer Coumadin testing in-house and perform a substantial, separate E/M service in  addition to the routine Coumadin clinic visit.

Note: Refer to the March 2003 Cardiology Coding Alert article "Keep Reimbursement Flowing With Coumadin Checkup" for more information.

When the cardiologist calls the patient to convey test findings, his phone call is included in the test itself or in the E/M service that he billed when the patient presented for testing.

Many practices conduct Protime tests with blood that they collect using a capillary stick (36416, Collection of capillary blood specimen [e.g., finger, heel, ear  stick]) instead of venipuncture (36415, Collection of venous blood by venipuncture, for non-Medicare patients and G0001, Routine venipuncture for collection of specimen[s], for those on Medicare). You should check with your nurse to confirm that he collects this blood by venipuncture. Blood collection by finger, heel or ear stick is not payable by Medicare and many other payers.

- You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, president of Compliant MD Inc. and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.