Cardiology Coding Alert

The time spent performing any of these procedures or services should not be included when calculating the amount of time involved in the transport of the critically ill or injured patient.

Any time spent treating the patient or coordinating care before the cardiologist assumes primary responsibility of the patient at the referring hospital or facility should not be included. And the time spent performing face-to-face care during transport ends "when the receiving hospital/facility accepts responsibility for the patient's care," CPT says.

These codes should not be billed in conjunction with 99082 (Unusual travel [e.g., transportation and escort of patient]). This carrier-priced code is used when a physician travels with a patient who is not critically ill or injured.

According to section 15026 of the Medicare Carriers Manual, this type of travel is generally already incorporated in the practice expense relative value units (RVUs) of any given procedure or service and is not separately payable. But carriers may pay separately if the physician "submits documentation to demonstrate that the travel was very unusual."

Medicare and Private Payers

The Medicare fee schedule says 99289 and 99290 have an "I" status, which means the codes are not valid for Medicare purposes. The fee schedule states that for such codes, "Medicare uses another code for reporting of, and payment for, these services."

Private payers may accept codes with the highest degree of specificity, based on CPT guidelines. Not only do 99289 and 99290 more accurately describe travel with a critically ill or injured patient, but the 2002 CPT manual specifically says in the introduction to the critical care section that "codes 99291-99292 should not be reported for the physician's attendance during the transport of critically ill or injured patients to or from a facility or hospital. Physician transport services of critically ill or injured patients are separately reportable, see 99289, 99290."

Therefore, unless specifically instructed not to use these codes by your payer, you should report such services with the new patient transport codes.

According to Marko Yakovlevitch, MD, FACP, FACC, a cardiologist in private practice in Seattle, accompanying a patient during transport is rare, but it does happen.

Yakovlevitch cites the following example: A 62-year-old woman with chest pain and hypotension presents at a rural hospital and is found to have an acute anterior wall infarction. She has a history of intracranial hemorrhage and therefore is not a candidate for thrombolytic therapy. The hospital does not have a cardiac catheterization laboratory. The cardiologist at the hospital administers aspirin and intravenous heparin and starts intravenous dopamine to support her blood pressure. He is concerned that she is having a large infarct and needs acute angioplasty to open the obstructed artery.

The patient remains unstable, so he decides to accompany the patient to a larger hospital in a nearby town. The trip takes 35 minutes, all of which the cardiologist spends face-to-face with the patient providing supportive therapy before the receiving hospital takes responsibility for her care.

In this case, the care provided to the woman during transport should be reported with 99289, assuming that at least 30 minutes of the face-to-face time the cardiologist spent with the patient is documented. The woman is not a Medicare beneficiary, and the private carrier prefers the new codes to critical care codes so utilization trends can be monitored.