Cardiology Coding Alert

Question: We are a multispecialty group that has expanded into cardiology. Our new cardiologist says that in addition to EKGs, he will be doing the following procedures in his office: event monitoring, exercise stress tests, and Coumadin clinic. Which CPT codes should we be researching? Can we use 99211 with the Coumadin clinic?


Georgia Subscriber

Answer: Most likely, you'll be using the following codes:

• For the EKG, 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report).

• For the event recorder global service, 93268 (Patient demand single- or multiple-event recording with presymptom memory loop, 24-hour attended monitoring, per 30-day period of time; includes transmission, physician review and interpretation).

Note: You should use the unlisted-procedure code (93799, Unlisted cardiovascular service or procedure) if your office provides less than 24 hours of attended monitoring.

• For the Holter monitor, 93230 (Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; includes recording, microprocessor-based analysis with report, physician review and interpretation).

• For the routine stress test, 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report).

• For the Coumadin clinic, you'll often use 85610 (Prothrombin time). The only time you'll report an E/M code (such as 99211, Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician ...) is if this evaluation service is medically necessary and is distinct and separately identifiable.

Note: You'll apply modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) only when your cardiologist provides the E/M service on the same day as a procedure with a global period.

Because 85610 has no global period, you don't need modifier 25. Many payers (including some Medicare carriers), however, will not properly process a claim with 85610 and an E/M code unless you attach modifier 25 to the E/M code. Ask your payers what they prefer.

For you to be able to report 99211, the documentation must support that staff provided a separate E/M service in excess of that typically provided to a patient merely coming in for the test. You must document medical necessity, such as noting that the patient is having difficulties with the medication.

You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition 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.