Cardiology Coding Alert

Question: The cardiologists I code for perform heart caths, but when the patient needs a stent, an interventional cardiologist puts in the stent. One of our cardiologists heard that the interventional cardiologist can report a consult or E/M for meeting with the patient. This idea was based on MLN Matters MM6740, which states, “Medicare may pay for an inpatient hospital visit or an office or other outpatient visit if one physician or qualified NPP in a group practice requests an evaluation and management service from another physician in the same group practice when the consulting physician or qualified NPP has expertise in a specific medical area beyond the requesting professional’s knowledge.” Can our group report a separate E/M for the interventional cardiologist?

North Carolina Subscriber

Answer: In theory, the MLN Matters article you cite supports reporting E/M service for both the cardiologist performing the heart catheterization and the one performing the stent insertion, assuming documentation supports a complete E/M by each. In reality, many practices have trouble getting paid for multiple E/Ms on the same date.

Don’t miss: CMS has indicated it is creating a new specialty code (C3) for interventional cardiology. The change is effective Jan. 1, 2015, and effective Jan. 5, 2015, according to MLN Matters MM8812 (www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8812.pdf).

Having separate specialty codes may help support reporting separate E/M services for each provider, but only time will tell.

Also keep in mind that if a physician performs an E/M on the same date he performs the stent procedure, you’d need to follow the rules for coding E/M services during the global period.