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Cardiology Coding Alert

You Be the Coder:

Don't Leave Medical Necessity High and Dry

Published on Thu Aug 18, 2005

Question: Should I consider medical necessity when reporting angiograms? In my report, the physician is selectively engaging the subclavians because he is looking for stenosis, but he also interprets the internal mammary artery and the RT common carotid through a nonselective injection with no diagnosis to support it. If the patient is going to have a bypass soon and the doctor is performing an angiogram of the mammary to see whether it is suitable for use, does that support medical necessity?


Tennessee subscriber


Answer: Yes, you should take medical necessity into account. You must also consider physician intent. For example, some practices might report carotids with a noncovered diagnosis and then write off when the payer denies the claim. Others might choose not to report it, depending on the payer and physician's input.

Payers usually cover a look at the internal mammary arteries to see whether they are patent for future bypass. Try using the diagnosis for the catheterization on the left internal mammary artery (LIMA).

In the case you described, you'll need to dig a little deeper before you can begin coding, so find a time to consult the cardiologist. Ask him, were the carotids and subclavian done for a particular reason (such as, carotid bruit, syncope, or subclavian steal syndrome) or just because they were on the way to the LIMA? Cardiologists may dictate path and findings on subclavian when they are going to the LIMA. Remember that you do not bill the subclavian if the intent clearly is to get to the LIMA. Carriers would consider these guiding shots and not separately reimburse for them.

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