Cardiology Coding Alert
Unlock Documentation Secrets to Catch +93571, +93572 Opportunities
Discover which codes to share with your cardiologist to earn an extra $100. Benefit: Medicare's national payment rate for the initial vessel is roughly $100,according to the physician fee schedule. 1. Understand Angio Connection for Better Coding The basics: The services +93571 (Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement [coronary vessel or graft] during coronary angiography including pharmacologically induced stress; initial vessel) and +93572(... each additional vessel) help the cardiologist determine the extent to which a coronary vessel or graft lesion blocks blood flow. A cardiologist typically performs the service in the cath lab. He records intravascular coronary blood flow velocity measurement using a tiny Doppler transducer mounted to a guide wire advanced through a diagnostic catheter, according to AMA's CPT Assistant (April 2000). He takes a baseline measurement, administers a stress agent to increase blood velocity, takes another measurement, and compares the two to determine the blockage's extent. Tip: CPT guidelines explain that +93571 and +93572 include manipulating and repositioning the transducer in the vessel the cardiologist is examining during coronary angiography or intervention. The device is so small that the doctor can advance it past the lesion without significantly increasing the lesion. This keeps the distal flow measurements accurate,according to CPT Assistant. The measurements can help the doctor decide whether a particular treatment, such as angioplasty or a stent, is likely to be sufficient for a lesion. The doctor also can take measurements after intervention to see whether it succeeded. 2. Plan Ahead for Add-On Success Codes +93571 and +93572 are add-on codes, as the "+" before the codes indicates. The CPT manual's "Introduction" explains that "add-on codes are always performed in addition to the primary service or procedure and must never be reported as a stand-alone code." Result: Medicare, for example, won't reimburse you if you don't report a primary procedure with +93571 and +93572, says Jennifer Hynes with Michigan-based Henry Ford Health System. A cardiologist typically performs the full service for the patient and at minimum would perform a heart cath for the transducer to reach the vessel(s). So you won't find a reason to report +93571 and +93572 without a primary procedure, says Hynes. CPT support: The AMA's CPT Assistant (April 2000) states that you should report the codes "in addition to the primary procedure (e.g., angiography, angioplasty)." Some primary code possibilities include cardiac cath codes 93508 and 93510, as well as stent placement code 92980, which you would report only once per vessel, Hynes says. Other possible primary procedures include cardiac cath injection procedures 93539, 93540, and 93545, aswell as angioplasty code 92982 and atherectomy code 92995, says Cheryl Klarkowski, RHIT, CPC, coding specialist with Baycare Clinic in Green Bay, Wis. Reality: Payers often limit which primary codes you may use with +93571 and +93572. Keep an eye on your particular payers' policies for updates. You also should keep your cardiologists up to date so they're sure to document the primary procedure and intravascular Doppler adequately. 3. Catch 'FFR' Reference Next Time To be sure you don't miss a chance to report +93571-+93572, keep a list of the alternate terms your cardiologist uses in an easy-to-spot place, such as next to the codes in your CPT manual. These terms in the documentation might be a clue to use +93571-+93572, Klarkowski says: • pressure wire • coronary flow reserve • fractional flow reserve (FFR) study • flow wire • intravascular distal blood flow • blood flow velocity. 4. For Once, Mod 26Won't Cut Pay Once you're sure you have proper documentation of the primary and add-on services, you need to dot your I's and cross your T's on your claim. Helpful: Medicare's physician fee schedule offers clues to proper +93571 and +93572 coding. If you look up these codes using the online search (www.cms.hhs.gov/PFSlookup/), you'll find that the fee schedule prices only the professional component, and the PCTC column has a "1." Translation: PCTC stands for "Professional Component/Technical Component" and the 1 indicates you can use modifiers 26 (Professional component) andTC (Technical component) with the code, according to the Medicare Claims Processing Manual, Chapter 23. As with any code that has a professional and technical component, you should report only what your cardiologist performs. So if the cardiologist performs the service in a hospital that bears the technical component cost, you should append modifier 26 to report the professional component. Payoff: The fee schedule indicates a national payment rate of $99.18 for +93571-26 and $77.90 for +93572-26. 5. Capture 'Each Vessel' for Max Payment Code +93571 covers the initial vessel and +93572 covers "each additional vessel," according to their descriptors. Troublemaker: Code +93572's reference to "each additional vessel" raises the question of whether each bifurcation or bypass is a new vessel or whether you should consider the whole coronary system to have three "vessels." If your payer doesn't offer guidelines in writing, experts recommend presuming three coronary vessels when you code these services: • left anterior descending (LAD or LD) • the left circumflex (LCX or LC) • the right coronary artery (RC), which includes the posterior ventricle branch, right posterior descending, acute marginal, right ventricle branch, conus, and sinoatrial (SA) nodal. If the cardiologist performs the study in all three "vessels," you should check your payers' reporting preferences. For example, "my Medicare specialist has said that location modifiers are not necessary," says Klarkowski, who is in Wisconsin. That means her providers are not required to append a modifier such as LC (Left circumflex), and appending those modifiers may in fact lead to denial. In this situation, you should report +93571-26 for the first vessel, +93572-26 for the second, and +93572-26 for the third, Klarkowski says.
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