Cardiology Coding Alert

The key to successfully coding and gaining reimbursement for diagnostic right and left heart catheterizations is mastering the four separately billable components of these procedures, which are the decision to perform the catheterization, catheter placement in the right and/or left sides of the heart, dye injection, and radiologic supervision and interpretation (S&I). Coders should be aware that many components of cardiac catheterization procedures are not separately billable, including the following:
History and physical (H&P) on the day of a scheduled catheterization
Local anesthesia and sedation
Repositioning of the catheter
Recording of pressures
Obtaining blood samples
Dilution curves
Cardiac output measurements
Fluoroscopy for catheter placement
Final report

Although these components are included in the catheterization procedure, the documentation should include this information to provide a complete record of all the services the physician provided during the procedure.   Coding experts give the following tips for stepping up your cardiac cath coding expertise: 1. Bill for Decision to Perform the Catheterization Accurately billing for a decision to perform a heart catheterization depends on whether the cardiologist makes the decision on the same day that he or she does the procedure.

If the physician makes the decision and performs the procedure on the same day, report the appropriate E/M service code according to where the service is provided. Typically, when the physician makes the decision for the catheterization and performs the procedure on the same day, the patient's condition is urgent, and the patient is in the emergency department (ED) or in the hospital, says Kathy Pride, CPC, CCS-P, a coding consultant for QuadraMed in Port St. Lucie, Fla.

If the cardiologist admits the patient to inpatient status from the ED, the appropriate code could be a hospital admission (99221-99223), Pride says. If the patient is already an inpatient under the cardiologist's care, you would report a subsequent visit code (99231-99233). Patients could also be admitted to observation status (99218-99220) rather than inpatient status. Observation status indicates that a supervising physician, who decides whether admission is appropriate, is monitoring a patient's condition, whereas inpatient status indicates that the patient has been admitted to the hospital. The distinction between observation and inpatient is critical in light of the HHS Office of Inspector General and Medicare's new focus on appropriate place-of-service coding, coding consultants say. Reserve Modifier -25 for Urgent Catheterizations Append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the appropriate E/M code to indicate to the insurer that [...]