Chest Pain Symptoms Offer Opportunities for Reimbursement

If you are treating a patient who also presents with chest pain, dont send him or her to the emergency department (ED) or a primary care physician. Order an electrocardiography (ECG or EKG) or other diagnostic tool and deal with the condition yourself. Not only is this prudent medically, but it offers the infectious disease (ID) physician an opportunity for additional reimbursement.

For example, a patient presents to the ID physician with a hand that has been bitten by a feral cat. During the exam for the animal bite, the patient complains that he is experiencing tightness in his chest and cant catch his breath.

Many ID physicians might send this patient to the local hospital emergency room or to a primary care physician. But the ID physician need not make that choice, says Dianna Hofbeck, RN, CCM, president of North Shore Medical Inc., a specialty billing service in Abescon, N.J. Under such circumstances, the ID physician is perfectly within good medical standards to obtain an ECG or EKG, she says. It wouldnt be prudent for the ID physician to ignore this condition. The ID physician should be ordering an ECG or EKG in this situation, no question about it. To not do so would waste valuable time as well as place the physician at risk for not diagnosing and prescribing expedient and appropriate care for a patient with chest pains.

When a patient presents with a problem unrelated to infectious disease, such as chest pain, the physician should take this into accountit is a secondary diagnosis, says Cathy Brink, CMM, CPC, president of Health Care Resource Management, a practice management and reimbursement consulting firm in Spring Lake, N.J. It is appropriate for the ID physician to code it as a secondary diagnosis, she adds, even if the patient is referred to a cardiologist later on.

In the earlier example, for instance, the animal bite (682.4) and infected finger (959.5) are the primary diagnoses, while shortness of breath (786.05), hypertension (405.19) and hysteria (780.02) can be cited as secondary diagnoses.

In addition to billing for administration of the rabies vaccine (V04.5), the ID physician can gain reimbursement for ordering (89.5) and reading the EKG (93272 [physician review and interpretation of cardiography]). Finally, the treating physician should bill 99215 (office or other out-patient visit for the evaluation and management of an established patient) for the associated evaluation and management (E/M) service, and V65.4 for case management.

Its true, Hofbeck adds, that in many cases chest pains and shortness of breath are caused by nothing more than an anxiety attack. She points out, however, Theres always the chance that the patient could arrest right there in the office. As a registered nurse and certified case manager, she strongly [...]

- Published on 2000-08-01