Part B Insider (Multispecialty) Coding Alert

Make sure you have coverage for this big-ticket therapy

Confused about enhanced external counterpulsation (EECP) therapy? Help is at hand.
 
As of January 2000, Medicare has its own code, G0166, for EECP, and will no longer recognize the CPT Codes that other payers reimburse. Luckily, Medicare pays more for that G code than private payers pay for all three CPT codes, according to one coder. EECP is a therapy that revascularizes the heart by pushing blood from the lower extremities up toward the heart, says Jim Collins with Compliant MD in Collins, N.C.
 
The patient's medical record should show the necessity for this therapy, which is usually repeated several times. "You have patients come in a couple of times a day" for several days running, Collins says.
 
"Our equipment provides a printout after each patient session that shows heart rate, pressure, blood pressure, oxygenation, etc., which is monitored throughout the session by our tech," says coder Karen Salowitz with the Heart and Vascular Center of Arizona.
 
"Our documentation in the patient's chart are readings supplied by the instrumentation on the EECP machine, and pre- and post-treatment blood pressure," adds Susan Scott with West Texas Medical Associates in San Angelo, Texas. The chart also includes patient history, current symptomology and any changes. "Our documentation is basically opened as an evaluation and management type encounter with modifications supporting EECP results."
 
Patients will qualify for EECP if "in the opinion of a cardiologist or cardiothoracic surgeon they are not candidates for invasive procedures or have high risks or have comorbid conditions," says Brian Weber, vice president of Marketing with Vasomedical in Westbury, N.Y., which makes EECP devices.
 
It's important to make sure your carrier covers this therapy before you provide it, because the expenses can add up, Collins says.
 
You can't bill daily evaluation and management codes (99211-99215) with EECP, states carrier Blue Cross and Blue Shield of Rhode Island in its local coverage policy. Carrier Empire Medicare Services says it will cover up to 35 sessions of EECP for angina, particularly 413.9.
 
Noridian also restricts EECP to angina (Class III or Class IV, according to the Canadian Cardiovascular Society Classification or equivalent).