Part B Insider (Multispecialty) Coding Alert

Payments have gone up, and primary procedure list has grown

Heads up: You could be letting extra reimbursement during coronary angiograms or cardiac catheterizations slip away.
 
Good news: The 2007 physician fee schedule raised the average payment for 93571 (Intravascular Doppler velocity and/or pressure derived coronary flow reserve measurement... initial vessel) by 7.4 percent to $99.29, and the payment for 93572 (...each additional vessel) rose 6.8 percent to  $77.31. But some providers are missing out on opportunities to bill these codes.

Terminology: Physicians use various techniques that you can bill for using 93571-93571. Look for terms such as -pressure wire,- -fractional flow reserve study,- or -Doppler ultrasonography- in your documentation. These all refer to a scan for coronary blood flow.

You can look for clues in your physician's documentation that he or she measured the coronary blood flow, says Cheryl Klarkowski, coding specialist with Baycare Health Systems in Green Bay, WI. She keeps a list of the -slang terms- for coronary blood flow measurement in her CPT book next to the entry for 93571.

Also: In the past, Medicare would only pay for 93571-93572 if he/she repaired a coronary lesion in addition to scanning it. But since 2001, Medicare will pay for 93571-93572 in conjunction with a coronary angiogram or cardiac catheterization too.

Medicare regularly updates the list of -primary procedures- you can bill 93571-93572 with, says Klarkowski. You should keep a list of primary procedures for these codes. -The payable list has changed since I originally started coding the flow wire,- she notes. -I would caution coders to keep the primary procedure list updated.-

She sent information about these codes, along with a list of the primary procedures you can bill them with, to her cardiologists. -The physicians are aware of the reimbursement and they rarely if ever- miss documenting this procedure, she says.

More confusion: The coding guidelines for 93571-93572 are unclear. The descriptor for 93572 refers to -each additional vessel.- But it's not clear if each bifurcation or bypass is a new vessel (as would be the case with a peripheral intervention), or if the whole coronary system only contains three -vessels- (as in coronary interventions.)

Answer: To bill for multiple coronary lesions, the physician should measure flow in different vessels. There are really only three separate coronary arteries and branches, says Christina Neighbors, charge capture/reconciliation specialist with Franciscan Health System in South Puget Sound, WA. The three vessels are the left anterior descending (LAD or LD); the left circumflex (LCX or LC); and the right coronary artery (RC), which includes the posterior ventricle branch, right posterior descending, acute marginal, right ventricle branch, conus, and SA nodal.

Important: Klarkowski tried billing for 93571-93572 using the LC, LD and RC modifiers to indicate which primary vessel the cardiologist scanned. She received denials from her carrier for these claims. Now, she doesn't use a location modifier for the vessel scanned. Instead, she treats each vessel the cardiologist catheterized to measure flow velocity as either initial or additional.