Cardiology Coding Alert

Bonus: 2 special case studies show you which UPIN/PIN to use when

When your cardiologist sends his nonphysician practitioner (NPP) to take care of the preliminary workup for a consultation, he could be cutting out 15 percent of his usual reimbursement. 

Follow this field-tested advice so you know when you should use the cardiologist's UPIN/PIN and when you should use the NPP's. How to Make Use of Shared Visits By delegating such tasks as admits, rounding and discharges to an NPP, your cardiologist is more available to take on higher-intensity--and higher paying-- services. But if your cardiologist uses an NPP to assist with consultations, you'll have to avoid billing the service under the doctor's name and number for Medicare patients.

Example: Your cardiologist is swamped with a full hospital census requiring rounding, two inpatient admissions, two patients who have been waiting three hours for discharge, one coronary intervention, and three urgent requests for consults that will go to another practice if your physician doesn't get to them immediately.

Get your money's worth: The cardiologist focuses on the urgent consult requests and procedures entirely by himself while sending the NPP to initiate the hospital admissions, discharges, and pre-round on the patients already admitted. Following the consultations, the cardiologist re-evaluates the patients just visited by the NPP, documents his face-to-face services with the patients, and reports for the combined service of the NPP and the cardiologist, as if the cardiologist had performed the entire service. Because he performed the complete consultations, you should report these consultations (99241-99245) under his UPIN/PIN.

Avoid this pitfall: Because the cardiologist believes the three consultations will take up to 45 minutes each, he sends the NPP in to obtain background information and narrow the visit down for him. When he goes in, he takes care of the end portion of the consultation visit.

You cannot report the consultations under his UPIN/PIN. Because the NPP participated in the consultation visit, you'll have to report the consultation under the NPP's UPIN/PIN and "receive 85 percent of the Medicare allowed amount for the NPP's work," says Nancy Lynn Reading, RN, BS, CPC, a coding educator with University Medical Billing at the University of Utah in Draper.

Didn't Know the Visit's Nature? Won't Help If you're trying to use the shared-visit rule for consultations--even when your cardiologist didn't know the visit was going to be a consultation to begin with--then you're not reporting these visits correctly.

Special case 1: The emergency department (ED) pages your cardiologist. In responding to the page, the cardiologist does not know the nature of the service--whether this is consultative (99241-99245), transfer of care (99201-99205), an admission (99221-99223) or a request that he provide ED care (99281-99285). He sends his NPP to perform [...]