Cardiology Coding Alert

If the physician treats a problem unrelated to surgery, the encounter may qualify as concurrent care or as a consultation. Both services may be reported separately if the documentation supports the claim.

Consultations. If a cardiac surgeon requests the opinion of the cardiologist for a different problem, the cardiologist can report a consultation. For instance, a bypass patient experiences atrial fibrillation postoperatively, and the surgeon requests the opinion of the cardiologist, who sees the patient in the hospital. If the cardiologist meets the criteria for a consultation (see Medicare Carriers Manual, section 15506), the appropriate-level inpatient consult (99251-99255) may be reported.

The request for the consultation and the medical necessity must be documented in the patient's medical record, and the cardiologist must give the requesting physician a written report of his or her findings. Any additional visits by the cardiologist should be reported using subsequent hospital care codes (99231-99233).

Concurrent care. The 90-day global period applies to routine follow-up care, which typically includes ensuring that wounds are healing and otherwise managing the patient's recovery. If the patient already sees the cardiologist for other problems, and care continues during the global period of the cardiac surgeon's procedure performed, it is separately payable.

In such cases, however, the cardiologist may report separately only the services that apply to the unrelated problem. To let the carrier know the E/M service is provided for a different problem, a different diagnosis should be associated with it.

Note: If the surgeon and the cardiologist are in the same practice, the cardiologist should append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period.