Cardiology Coding Alert

Find out why this clarification is good news for your practice Just because auditors are targeting modifier 25 doesn't mean you should cut out your use of this tool. CMS recently clarified how you should use modifier 25. See if these common cardiology scenarios do or do not merit its use.
  
Recent reports of the Office of Inspector General (OIG) targeting claims containing modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) have raised concern in cardiology practices.
 
Bottom line: "Every coder should always be concerned and reverent when using modifier 25," says John F. Bishop, PA-C, CPC, president of Bishop & Associates  Inc. in Tampa, Fla. "The OIG has really cracked down on this modifier and collected huge sums of money for inappropriate coding." 
 
Best bet: You should only use modifier 25 when your cardiologist provides a significant and separately identifiable E/M service on the same day as a procedure with a global period, says Jim Collins, CPC, ACS-CA, CHCC, CEO of the Cardiology Coalition in Matthews, N.C. You can read the CMS clarification (implementation date Aug. 1) at www.cms.hhs.gov/transmittals/downloads/R954CP.pdf.
 
Scenario 1: Study This Same-Day Stress Test Example A cardiologist sees a patient for an E/M service and decides to perform a stress test, having room on his schedule for a stress test on the same day.
 
"Because the recent CMS clarification states that you should only apply modifier 25 with an E/M code when a procedure has a global period, you should not use a modifier 25 in this situation," Collins says. "The stress test does not have a global period."
 
Because the E/M service is significant and separately identifiable, you can still report both the E/M and stress test codes. You simply do not need modifier 25 appended to the E/M code.
 
To report the stress test, you should use the following codes: 93016 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report), 93018 (... interpretation and report only, if performed in the hospital) and 93015 (... with physician supervision, with interpretation and report, if performed in the office). Scenario 2: Learn About Image-Guided Interventions The cardiologist sees an inpatient in consultation for acute ischemia of the foot. The cardiologist advises angiography with possible percutaneous intervention. Later that day, the patient undergoes angiography and mechanical thrombectomy of the popliteal artery.
 
Report the inpatient consultation (99251-99255) with modifier 25, as well as the angiogram and thrombectomy. "If the cardiologist makes the decision to perform the cath on the same day, you should bill for this service separately," says Melissa Bedford, coding specialist at [...]