Tag Archives: cardiology
MACs Differ on Response to CMS’s Cardiology Payment Adjustments
Posted on 27. May, 2010 by Editor.
Don’t look for a raise just yet, in most cases.
CMS may talk, but MACs don’t always listen — at least not quickly.
As we told you in last week’s Insider, CMS recently corrected several “technical errors” published in the 2010 Fee Schedule, and thanks to these corrections, Medicare will increase payment for several cardiology-related testing codes, including codes 75571-75574 (Heart CT) and 78451-78454 (Heart muscle SPECT imaging).
Although many practices are eager to see the payment boosts in their next Medicare payments, that may be an overly ambitious goal at this point.
“I inquired with a few MAC carriers such as Trailblazer, Noridian, and Palmetto, and was told different things by different Medicare payers,” says Terry Fletcher, BS, CPC, CCS-P, CCS, CMSCS, CCC, CEMS, CMS, CEO of Terry Fletcher Consulting Inc.
“One did not even know there was a change,” she says. “Next,
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Check 33208 Global to Prevent E&M Snafu
Posted on 07. May, 2010 by Editor.
When an EM service occurs during a postop global period for reasons unrelated to the original procedure, use this modifier.
Question: If the cardiologist performs a pacemaker insertion in the hospital and later visits the patient in observation, should I code the observation visit?
Georgia Subscriber
Answer: You should not charge this visit separately. Pacemaker insertion code 33208 (Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial and ventricular) has a 90-day global period.
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93000-93010: Hone Your ECG Coding Skills With 3 Essential Pointers
Posted on 28. Mar, 2010 by Editor.
Grasping 93010’s effect on new vs. established patient status could bring a $58 reward.
Whether you call them ECGs or EKGs, chances are you see a lot of electrocardiograms in your practice. That means that even the tiniest coding errors can add up quickly. Brush up on the 93000-93010 basics with this review of the service, the code components, and the role ECGs can play in choosing the proper E/M code.
1. Count on These Codes for Proper ECG Reporting
There are three codes for routine ECG:
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CPT 2010: Add New AV Shunt Codes to Your Toolbox
Posted on 13. Dec, 2009 by Editor.
Initial vs. additional access matters in 2010.
Love them or hate them, the trend toward guidance-inclusive codes doesn’t seem to be slowing.
Case in point: CPT 2010 ousts 36145 (Introduction of needle or intracatheter; arteriovenous shunt created for dialysis [cannula, fistula, or graft]) and 75790 (Angiography, arteriovenous shunt [e.g., dialysis patient], radiological supervision and interpretation) and instead instructs you to consider the following new surgical codes — which include imaging:
• 36147 — Introduction of needle and/or catheter, arteriovenous shunt created for dialysis (graft/fistula); initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report (includes access of shunt, injection[s] of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava)
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2 New 2010 CPT Codes for High-Tech Cardiology Services
Posted on 08. Nov, 2009 by sanjay.aikat.
Steer clear of Cat. I codes for intravascular spectroscopy — here’s where to look instead.
The CPT update season is fast approaching. Warm up for the changes coming your way with a look at new-for-2010 Category III codes aimed at diagnosing coronary artery disease.
Match 0206T to MCG
One of the new Category III codes with a Jan. 1 implementation date is 0206T (Algorithmic analysis, remote, of electrocardiographic-derived data with computer probability assessment, including report), which is appropriate for Premier Heart’s Multifunction CardioGram (MCG).
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OIG Auditors to Cardiologist: You’re Billing Medicare Properly
Posted on 20. Oct, 2009 by Editor.
Report reveals what he and his billing staff did right. Does your practice have the right stuff?
Turns out the old saying is true: If you haven’t done anything wrong, an OIG audit is nothing to worry about.
A New York cardiologist who collected over $1.3 million over a three-year period for 5,061 claims caught the OIG’s eye due to a “high volume of Medicare claims in comparison to other cardiologists throughout New York state,” according to the OIG’s report on the topic, which was released on Oct. 14.
The OIG reviewed the cardiologist’s records for the three-year period, but found that the physician, who specialized in non-invasive procedures, complied with Medicare reimbursement requirements. Therefore, the OIG made no recommendations and did not request any fund recovery from the physician.
What your practice can learn: If you have a physician who specializes in a particular condition or procedure and treats lots of Medicare patients, the feds’ data mining techniques may very well flag your practice for an audit. But if your coding and documentation are correct, you can breathe easier as your physician does what she does best.
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Cardiology Coding Education: Pacemaker Lead Check
Posted on 15. Sep, 2009 by Editor.
Question: The cardiologist documented testing pacemaker leads using fluoroscopy (71090) in the hospital. Which code is appropriate for the testing?
Answer: You mention 71090 (Insertion pacemaker, fluoroscopy and radiography, radiological supervision and interpretation), which is specific to radiological supervision and interpretation at the time of device insertion. So presumably the cardiologist was testing the leads at the time the patient first received the pacemaker.
You can’t report lead evaluation separately at the time of pacemaker insertion (such as 33206-33208).
Verify device: Doctors sometimes document “pacer” when referring to a pacing automatic internal cardioverter defibrillator (AICD), so confirm which device the cardiologist is referring to. You may report one of the following two codes for evaluating leads at the time of an AICD insertion:
• 93640-26 — Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement; Professional component.
• 93641-26 — … with testing of single or dual chamber pacing cardioverter-defibrillator pulse generator.
Code 93640 is appropriate when your cardiologist performs the EP AICD lead evaluation before he connects them to the pulse generator. This is rare.
In contrast, 93641 is much more common and represents the cardiologist testing the entire system once he connects the pulse generator. It requires induction of ventricular tachycardia/fibrillation to assess the system’s defibrillation capabilities. So you would not report 93641 for just testing the lead for pacing thresholds and sensitivity.
AUDIO: Heart Anatomy 101 — a coder’s CABG survival kit from Betty Johnson.
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Heart Cath Coding Education That Stops Denials
Posted on 31. Aug, 2009 by Editor.
1 simple ‘cross the aorta’ rule keeps 93510 denials at bay.
Matching “left heart catheterization” to 93510 (Left heart catheterization …) may seem like an easy day’s work. But not so fast. The cardiologist must meet and document a crucial left ventricle requirement for you to choose this code. Work your way through this case study to see if 93510 belongs on the claim.
Test Yourself With Facility-Based Example
Get started: Assume that the sample case below took place in a facility that will report the technical component, and you are reporting only the professional component.
Remember to append modifier 26 (Professional component) to codes that have a professional and technical component, says Heather R. Stecker, CPC, ACS-CA, compliance director and reimbursement manager for Cardiology Consultants of Philadelphia. That way the payer knows you are asking for reimbursement of physician services only.
Procedure: Left heart catheterization, bilateral selective coronary arteriography, radiological interpretation.
Indication: Equivocal stress echocardiogram for ischemia with development of chest pain on the treadmill, and equivocal lateral wall ischemia being noted.
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Bundle of His Recording Coding Challenge
Posted on 13. Jul, 2009 by Editor.
Question: How should I report right atrial pacing and recording when performed with bundle of His recording? May I report 93619 or should I append modifier 52?
Answer: When the cardiologist performs right atrial pacing and recording as well as bundle of His recording, but does not perform the other services described in 93619 (Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia), you should not report 93619.
You also should not report 93619-52 (Reduced services) because you have a more appropriate coding option:
• 93600 — Bundle of His recording
• 93602 — Intra-atrial recording
• 93610 — Intra-atrial pacing.
You should report these three individual codes because the cardiologist did not perform and document the other services listed in 93619’s descriptor.
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