Cardiology Coding Alert

Question: We capture charges and diagnoses for in-office diagnostic tests by routing the batch of completed test order forms daily to staff who enter charges into the billing system from encounter forms. This is working very efficiently for our practice, but we're concerned about coding from documents other than the actual report.  Specifically, we cannot verify that the cardiologist actually performed and documented each component of the tests. Are my concerns warranted?

Minnesota Subscriber
 
Answer: Yes, your concerns are warranted and are actually just a small part of the problem. The physician must separately document each component of the diagnostic tests in the final report. Many providers do not understand that the individual components of services must be separately documented. By coding from the order form, you are assuming that your physicians performed and documented each component of the tests.

A potentially worse concern involves diagnosis coding. Physicians should report the findings of diagnostic tests on claims when the test is positive, according to HIPAA requirements.

You should report negative tests with the diagnosis code that accurately reflects the indication for the study. By capturing your diagnosis codes from the test order form, you will typically be reporting the indication for the study rather than the finding. When these tests are positive, the appropriate diagnosis would be the finding rather than the indication. For instance, your physician may order a myocardial perfusion study for a patient with angina (413.9). If the test identifies coronary artery disease (414.01), you should report this diagnosis as primary rather than the indication for the test (angina.)

If you are coding from the order form rather than the final interpretation, your claim will frequently be inaccurate because the claim will list the indication rather than the findings.

Many cardiology groups do not have same-day test results. Echos (93303-93350) and nuclear study images (78459, 78466-78469), for example, may not be officially interpreted for a few days following the test. Until the physician interprets these tests, you would not have an accurate diagnosis to report.

Further, you should report screening services with the appropriate V code, regardless of the findings. For example, if the cardiologist performs a screening echocardiogram at the request of the patient and finds that the patient has aortic regurgitation (424.1), you would report the test with a screening code (such as V81.2, Special screening for cardiovascular disease; other and unspecified cadiovascular conditions) rather than the code for the  finding of aortic regurgitation.