Wiki Billing E/M on same day as planned heart cath

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haileynicole3

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Hello,

I have a doctor who does heart caths on another cardiologist's patients. The other cardiologist determines that the patient needs a heart cath and schedules it at the hospital but he does not do heart caths so my doctor comes in on the day of the heart cath and sees the patient for the first time. He then does an H&P prior to the heart cath and wants to bill the e/m for the H&P. In my opinion he is not doing the H&P to determine if the patient needs the heart cath, the patient is already there to have it. I have tried to explain to my doctor that the e/m is included with the heart cath on the same day if it is already planned. I told him if he wants to actually see the patient prior and bill for an e/m he would need to see the patient in his office on a day prior to the heart cath. He states he has been doing it this way for 25 years and as long as it is getting paid I should just bill it. I am trying to find acutal CMS guidelines to show him that is not proper billing. I have been on the CMS website and can not find anything. Can anyone help me with this?

Thank you in advance...
 
Hello,

Your can find the guideline for this in two different places:
(1) CMS IOM-100-04, Chapter 12, Section 40.1 - Definition of a Global Surgical Package

http://www.cms.gov/Regulations-and-...12.html?DLPage=1&DLSort=0&DLSortDir=ascending

and

(2) NCCI Manuals - Chapter XI - Medicine, Evaluation and Management Services (CPT Codes 90000 - 99999) - Section U regarding Global Days.
http://www.cms.gov/Medicare/Coding/...ndex.html?redirect=/nationalcorrectcodinited/

Please keep in mind that the NCCI edits apply to "same day services by the same provider to the same beneficiary".



I hope this helps....
 
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