Cardiology Coding Alert

Experts explain how to recoup your practice's ultrasound pay

When cardiologists perform intravascular ultrasounds (IVUS) to diagnose lesions or to help guide therapeutic interventions in the coronary or peripheral vessels, make sure you've got a grip on the primary diagnostic or interventional procedure--this must be crystal-clear to report the IVUS study.
 
First, Investigate These IVUS Basics What it is: Cardiologists use IVUS in coronary and peripheral arteries to diagnose problems such as the amount of plaque burden and the amount of calcium in the vessel wall. IVUS can be a quantitative aid to determine the degree of coronary stenosis.

Physicians may use intravascular ultrasound during cardiac catheterization, interventions (such as percutaneous transluminal coronary angioplasty [PTCA], atherectomy or stent placement), or to assess treatment results. During an IVUS, the physician places a special ultrasound catheter in the vessel to visualize its structure. Although an IVUS has obvious diagnostic applications, some carriers may be reluctant to pay for this study, restricting coronary ultrasounds for therapeutic procedures only or rejecting peripheral ultrasounds altogether.

Problem: Some insurance carriers will try to deny IVUS codes, especially when the cardiologist performs a diagnostic procedure only, says Sandy Fuller, compliance officer at Cardiovascular Associates of East Texas. "You'll see this discussed a lot in the cardiology discussion group," Fuller says. (To join the free e-mail discussion group, go to www.coding911.com.)

Good news: If you demonstrate appropriate medical necessity for the visualization service with a primary procedure, however, you may have an easier time convincing payers to reimburse. 

Example: A physician may note that an angiography study does not clearly reveal whether plaque is significantly narrowing a vessel and may document that the IVUS yields a more accurate assessment of the degree of narrowing, says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.

In addition, IVUS can give more information about plaque pathology, such as the presence of significant calcium, a thrombus or dissection within the artery, Williams says.

Your physician can use these details to guide the appropriate interventional therapy, so you should look for this information in the procedure note.

Follow these three expert tips for improving your IVUS reporting: 1. Pair IVUS With Primary Procedures First, both the coronary and peripheral IVUS codes are add-on codes, so don't try reporting them without the accompanying primary service, or you'll face denials, says Jennifer Bankhead, RHIT, CPC-H, CIC, specialized coding analyst for St. Joseph's Mercy Hospital in Hot Springs, Ark.

In other words: "Because you'll be using add-on codes, you have to match them up to the correct primary codes," says Yvette Hofmeister, CPC, coding analyst for OSU Internal Medicine in Columbus, Ohio.

When cardiologists perform IVUS with coronary interventions, including stenting and PTCAs, report +92978 (Intravascular ultrasound [...]