Cardiology Coding Alert

Question: Some of our patients are about to undergo non-cardiology-related general surgery and have been sent to us for preoperative clearance. How should we code this?

New York Subscriber

Answer: Cardiologists are often asked to clear a patient for a non-cardiac-related surgery before the procedure is performed. For example, an orthopedist may send a patient who is about to have a hip replacement to the cardiologist to evaluate the patient's cardiac status prior to surgery.

Until May 2001, some carriers would not pay for preoperative clearances if V codes (such as V72.81, Preoperative cardiovascular examination) were the primary diagnosis for the visits. In 2001, however, Medicare instructed Part B carriers to accept V72.81 and the other preoperative clearance V codes. Specifically, Medicare has instructed carriers to "delete any processing edits that deny claims or identify for manual review ICD codes V72.81-V72.84" and has said that designating V72.81 as the primary diagnosis code indicates the medical necessity for the service. Section 15047C of the Medicare Carriers Manual states that all medically necessary clearances (i.e., those that involve "evaluating a patient's risk of perioperative complications") will be covered.

The diagnosis code that prompted the decision to obtain a cardiovascular preoperative clearance should be listed as a secondary diagnosis, according to Medicare. In areas where the local Part B carrier routinely denied claims that used V72.81 as a primary diagnosis, some cardiologists would use this condition (for example, tachycardia or coronary artery disease) as the primary diagnosis to get paid. This was inappropriate because the purpose of the visit was not to treat the patient's condition but, rather, to perform a preoperative clearance.

The reason for the surgery should also be included. In the case of the patient who requires a hip replacement, the appropriate ICD-9 code should be listed as a third diagnosis.

The answers to You Be the Coder and Reader Questions were provided by Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan.; Marko Yakovlevitch, MD, FACP, FACC, a cardiologist in private practice in Seattle; Lisa M. Clifford, CPC, owner of the multispecialty coding firm Clifford Medical Billing Specialists Inc. in Naples, Fla.; and Sandy Fuller, CPC, a cardiology coding and reimbursement specialist in Abilene, Texas.