Streamline Your IVUS Coding With 3 Tips
Published on Wed Nov 05, 2003
Experts explain how to recoup your practice's ultrasound pay
When cardiologists perform intravascular ultrasounds (IVUS) to diagnose lesions or to help guide therapeutic interventions in the coronary or peripheral vessels, make sure you've got a grip on the primary intervention procedure - this must be crystal- clear to report the IVUS study.
Cardiologists use IVUS in coronary and peripheral arteries to diagnose problems such as the amount of plaque burden and the amount of calcium in the vessel wall, and as a quantitative aid to determine the degree of coronary stenosis.
Physicians may use intravascular ultrasound during cardiac catheterization, interventions (such as percutaneous transluminal coronary angioplasty [PTCA], atherectomy or stent placement), and to assess treatment results. During an IVUS, the physician places a special ultrasound catheter in the vessel to visualize its structure.
Although an intravascular ultrasound has obvious diagnostic applications, some carriers may be reluctant to pay for this study, restricting coronary ultrasounds for therapeutic procedures only or rejecting peripheral ultrasounds altogether.
Some insurance carriers will try to deny IVUS codes, especially when the cardiologist performs a diagnostic procedure only, says Terri Davis, CPC, cardiology coder and coding supervisor at the University of Oklahoma College of Medicine
Even so, if you demonstrate appropriate medical necessity for the visualization service with a primary procedure, you may have an easier time convincing payers to reimburse.
For instance, a physician may note that an angiography study does not clearly reveal whether plaque is significantly narrowing a vessel and may document that the IVUS yields a more accurate assessment of the degree of narrowing, says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.
In addition, IVUS can give more information about plaque pathology, such as the presence of significant calcium, a thrombus or dissection within the artery, Williams says. These details can be used to guide the appropriate interventional therapy, so coders should look for this information in the procedure note.
Experts offer three tips for improving your IVUS reporting: 1. Pair IVUS With Primary Procedures Both the coronary and peripheral IVUS codes are add-on codes, so don't try reporting them without the accompanying primary service, or you'll face denials, Davis says.
When cardiologists perform IVUS with coronary interventions, including stenting (92980) and PTCAs (92982), report +92978 (Intravascular ultrasound [coronary vessel or graft] during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation and report; initial vessel [list separately in addition to code for primary procedure]) for the initial vessel ultrasound and +92979 for each additional vessel.
Similarly, add peripheral vessel IVUS codes +37250 (... [non-coronary vessel]; initial vessel [list separately in addition to code for primary procedure]) and +37251 (... each additional vessel), as appropriate to peripheral interventions. If you're not sure which [...]
