Cardiology Coding Alert

Cardiologists routinely purchase and bill for a wide variety of medical supplies and related materials. Most of these fall within one of four main categories: (1) pharmaceutical stress agents, (2) radioisotopes for nuclear scans, (3) contrast agents for echocardiography and (4) other injectable medications. Reporting the use of supplies can be tricky, and incorrect coding may result in denials and payment delays. Among the difficulties are the following: Most of the supplies used by cardiologists are reported to Medicare carriers using the less familiar HCPCS codes. Not all supplies are in the same section of the HCPCS manual. Codes for the same material vary based on amounts used. Generic names are used even when the material is commonly known by a brand name. In addition, because the supplies are first purchased by the cardiologist and are then supposed to be billed with no markup to Medicare, the Part B carrier may require an explanation, and in some cases an invoice (for which a paper claim would be necessary), to verify that only pass-through charges are billed. Pharmaceutical Stress Agents If a patient cannot walk on a treadmill, the cardiologist may decide to stress the heart pharmacologically. Although the reporting of the test is the same, when stress is induced this way, the supplies may be separately reported.

Among the most common stress agents are dobutamine, dipyridamole (Persantine) and adenosine. Dobutamine directly stimulates the heart by boosting the heart rate, coronary blood flow and oxygen requirements, and is used with stress echocardiography or nuclear scans (for example, thallium stress tests). Adenosine and Persantine are vasodilators that boost blood flow by opening up the coronary arteries. They are used for nuclear scans but not stress echos. The HCPCS manual lists these and other stress agents as follows: J0151 Injection, adenosine, 90 mg (not to be used to report any adenosine phosphate compounds; instead use A9270)
J1245 Injection, dipyridamole, per 10 mg (Persantine IV)
J1250 Injection, dobutamine HCl, per 250 mg (Dobutrex)
J0280 Injection, aminophylline, up to 250 mg
J3490 Unclassified drugs. When adenosine is used, report J0151, not J0150, says Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan. "J0150 is also for adenosine, but the small dosage (6 mg) is used to convert a patient out of an arrhythmia, not to induce stress," she says. Many carriers will cover pharmacologically induced stress testing only when the patient cannot tolerate exercise, and they may want to know why stress was induced with drugs. In addition to ensuring that the documentation supports the claim, a short explanation should be included on the claim form, says Rebecca Sanzone, CPC, coding manager for Mid-Atlantic Cardiovascular Associates, a [...]