Cardiology Coding Alert

Showing doctor involvement clinches $15 per session To report clean claims for your cardiac rehabilitation services, you'll need the right documents, including the attending physician's script, the supervising physician's signature on exercise sessions, and plenty of support for separate services during rehab sessions.

By now, you're aware that the HHS Office of Inspector General (OIG) is targeting cardiac rehab programs in this year's Work Plan. (See "Get Your Dx Right for CPT 93798 and Cash in on Cardiac Rehab" in the April 2004 Cardiology Coding Alert for more on how to report cardiac rehab services.)

So far this year, the OIG has audited 34 cardiac rehab programs to make sure they are meeting current Medicare coverage requirements. Missing Notes Attract Scrutiny To keep your practice in the clear, review the following four most common problem areas identified by the OIG: 

Problem 1: The physician's professional services were not apparent.   

Lesson learned: Make sure your cardiologist performs both initial and subsequent services to reflect active participation in the course of treatment. "It's very important that the treating physician provide a written prescription for cardiac rehab services," says Sheldrian Leflore, CPC, a cardiology-coding consultant with Gates, Moore & Company in Atlanta.

Real-life advice: Before billing 93798 (Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring [per session]), document everything, says Happiness Miller, RN, an auditor with the cardiac catheterization lab in Central Baptist Hospital in Lexington, Ky. "Our outpatient cardiac rehab department has the patient's physician sign the prescription, the initial plan of care, the six-week update, and the follow-up documentation," she says. Getting your documentation right will eliminate reimbursement woes. Indeed, Medicare pays about $15 per facility session for 93798, according to national averages in the 2004 Physician Fee Schedule --and for a patient on a six-week protocol, this can really add up.

Also, remember that cardiac rehab services (93797 and 93798) have a zero-day global package. To bill for any additional physician services on the same day as cardiac rehab, append modifier -25 (Separately identifiable evaluation and management service ...) to the appropriate E/M code to prevent bundled-service denials. For instance, the physician might perform an interim physical exam to assess the therapy's impact and to make sure no adverse events are imminent. In this situation, you would report an established patient office visit (for example, 99213-25) and the cardiac rehab service. 

Problem 2: The reports didn't identify the supervising physician. 

Lesson learned: Be very clear about documenting who the supervising physician is for each cardiac rehab service.

A CMS official provided Cardiology Coding Alert with the following definition of direct supervision for cardiac rehab services: "It does not require that a physician be physically present in the exercise [...]