Cardiology Coding Alert

At least 1 contractor offers hope when admitting physician forgets AI.

If you’re still a little gun shy about letting go of strict consult coding requirements or reporting pre-op visits that used to be consults, you’re in good company.

NGS, which administers Part B for Connecticut , Indiana, Kentucky, and New York, offered a Feb. 9 Medicare Part B Consultation Coding Changes conference call to alleviate confusion about consult code elimination. Here are some of the highlights.

Don’t Fret If Other MD Forgets AI

Cardiology coders, like many specialty coders, have wondered what would happen if the principal physician forgets to append modifier AI (Principal physician of record), which CMS introduced for attending physicians to use on the initial inpatient hospital care code. (For more information, see Cardiology Coding Alert, Vol. 12, No. 15,

“Cross Consult Codes Off Your Medicare Options Jan. 1.”) One caller asked whether NGS intends to wait for the attending physician’s initial hospital care claims (denoted by modifier AI) before it will pay initial hospital care claims submitted by other specialists. “No, AI is informational only,” said Linda Teti, CPC, provider outreach and education consultant with NGS. And informational modifiers do not influence whether a claim is processed and paid. “In a perfect world, the doctor following the patient’s care will submit with the AI modifier and everyone else wouldn’t, but if someone put it on in error or someone forgot to put it on, it won’t affect payment,” she advised.

No Consult Means No Referring MD

Providers frequently ask the NGS Medicare reps whether they must report the referring or ordering physician’s name on Item 17 of their claim form. That is not a requirement anymore, Teti indicated.

“However, including in your documentation who the patient was referred from and the reason for that visit in the report is simply good medical practice,” Teti said.

Remember: Because Medicare no longer pays consult codes, there is no longer an absolute requirement for a consultation request and report, as was previously specified in the consultation documentation requirement. Instead, you should make sure to meet the E/M service documentation coding requirements for the code you report.

Keep Pre-Op Diagnosis the Same

Practices that previously reported consultation codes for preoperative clearances expressed confusion about which diagnosis codes to use for the visits, now that the exams are no longer considered consults.

In the past, practices used a code such as V72.81 (Preoperative cardiovascular examination) as the ICD-9 code for the consult, but one caller asked which diagnosis she should report going forward for these visits.

The primary diagnosis code should be the V code for the surgical preoperative exam, and the secondary code should be the diagnosis code representing why the surgery is being performed, said Karen Drake, RN, CPC, a provider outreach and clinical education consultant with NGS.

“Keep in mind that you want to support the medical necessity for doing that pre-op clearance,” Teti said. “For example, the patient comes to you and has a history of heart disease, and that’s why a cardiologist is going to be seeing him -- you want to make sure you’re going to be using diagnoses that will support the medical necessity of the visit.”