Cardiology Coding Alert

This expert checklist gets you from reviewer to reimbursement with no fuss

Reporting unlisted procedures is more than a hassle--it requires extra time and work sometimes for a minimal payoff, but you can streamline your efforts using the following tips.

Scenario: Your cardiologist cardioverts a patient by firing the patient's internal defibrillator. You try to find a CPT code to represent this procedure, but you can't locate one.
 
You'll likely have to look at the unlisted-procedure code 93799 (Unlisted cardiovascular service or procedure), says Sandy Fuller, CPC, compliance officer at Cardiovascular Associates of East Texas in Tyler. But your billing process shouldn't end there.

Take the hassle out of the process by following this plan for better unlisted-procedure claims, says Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and AAPC National Advisory Board president.

1. Offer a detailed description of the procedure performed. Describe what a cardioversion through an implanted device is in layman's terms--your reviewer may not be familiar with cardiology.

Example: You can describe the procedure like this: "An external cardioversion is the application of timed electrical stimuli through the patient's chest with external electrodes."

Best bet: Also, you should show that internal cardioversion is a similar procedure but one in which the cardiologist passes electrodes to the inside of the patient's heart through a transvenous approach. Using a device is somewhat of a hybrid procedure, meaning that you aren't likely to find a regular CPT code to represent it.

2. Include copies of articles in medical journals supporting the reasonableness of the procedure, such as clinical trials and medical indications.

3. Don't forget documentation of medical necessity to back up the decision to perform the procedure. For example, you should show that the patient has a persistent arrhythmia through EKG results or information retrieved from the device.

4. Explain the time, effort and equipment required to perform the procedure, both to help the reviewer understand the procedure and to support the amount of reimbursement you request.

5. Remember to submit the patient's indications--diagnosis, chief complaint, presenting signs and symptoms, and any concurrent problems the patient has that require treatment or management.

6. Describe the patient's follow-up care and prognosis.

7. Relate the procedure performed to an existing procedure as support for reimbursement. And explain how your procedure differs to show why you didn't choose the existing code, says Heather Corcoran, manager at CGH Billing Services in Louisville, Ky. Basing your fee on a similar procedure is helpful in claims processing but not mandatory.

For the scenario above, you should request reimbursement at a level somewhere between that of 92960 (Cardioversion, elective, electrical, conversion of arrhythmia; external) and 92961 (... internal [separate procedure]), keeping in mind that using an implanted device to perform cardioversion does not necessarily match either code.

8. Never underestimate the power of demonstrating cost savings from the procedure you chose. If you can illustrate how your procedure will cost the payer less in the long run than the typical course of treatment, your payer should be happy to accept your unlisted procedure.