Cardiology Coding Alert

Question: Our cardiologist dictated an observation admission note (comprehensive history, comprehensive exam, moderate level of complexity) for a patient coming to the hospital for a scheduled heart catheteriza-tion. Which code (including any modifier) should I submit for this observation admission, assuming the patient was discharged nine hours following the procedure?
     
California Subscriber


Answer: You would not report a code for the scenario you describe because the service falls in the "000" global period of the heart catheterization. Separate E/M services would only be billed on the day of a heart catheterization if, during the evaluation, the physician made the initial decision to perform the heart catheterization or if the physician saw the patient for a reason completely unrelated to the reason for the heart cath. 
 
When a physician makes the heart catheterization decision on the same day, you report the appropriate E/M service and append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).
 
For example, if an emergency department physician refers a patient to a cardiologist for evaluation of unstable angina, and the cardiologist chooses to perform an urgent catheterization with stenting, you would report 99223-25 for the initial hospital care provided by the cardiologist; 93510 for the left heart catheterization; 93543 for the selective angiography during the catheterization; 93545 for the selective coronary angiography; 93555 and 93556 for the imaging supervision, interpretation and report during the catheterization; and 92980 for the stenting.