Cardiology Coding Alert

Use 3 tips to fine-tune your test reporting

When your cardiologist provides an E/M service and performs an in-office diagnostic test, you'll need to know when the physician scheduled the test and the nature of the pre- and posttest work to report the office visit correctly.

To make sure your providers receive their fair share for in-office testing services, our experts say you should implement these three rules of thumb:

1. Bill the E/M with the test if the patient receives the test in the office on the same day as the visit.

If the cardiologist decides to perform a diagnostic test such as an echocardiogram or a nuclear study on the same day as the office visit, you should report the appropriate diagnostic test code and the office visit code. You should also append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code. Appending modifier -25 will tell payers that the E/M service is separate from the usual patient evaluation that is necessary before, during and after the diagnostic test. 

Here's a same-day test example: An established patient comes in complaining of palpitations (785.1) and light-headedness (780.4). The provider performs a complete cardiac workup and orders a same-day, in-office echocardiogram.

To report the visit, bill the echo as 93307 (Echocardiography, transthoracic, real-time with image documentation [2D] with or without M-mode recording; complete). You may need to add additional codes,  depending on the equipment and images the physician obtained. Report the office visit with 99214 (the level would depend on the physician's documentation), and append modifier -25 to the E/M code, says Tina Landskroener, CCS-P, chief operating officer of Total HealthCare Compliance in Las Vegas.

2. On the day of a scheduled diagnostic test, you should bill an office visit only if the physician's service exceeds the typical services he provides to a patient receiving the diagnostic test.

There is a certain amount of pre- and posttest work associated with each diagnostic test, such as assessing the patient's condition, prepping for the test, and reviewing results, but this work is not separately billable, Landskroener says.

When the physician provides a substantial service in excess of the typical pre- and posttest service, you can bill the office visit with modifier -25 attached. Keep in mind that abuse of this billing provision will, most likely, attract regulatory attention.

For instance: If a patient scheduled for an echocardiogram complains of a new symptom or has high blood pressure during the pre- or posttest phase, the physician may need to give an injection to lower the blood pressure or check for fluid retention. He may also perform a complete exam before or after the echocardiogram, says Colleen McKee, CPC, senior coding consultant and team leader with Knoxville Cardiovascular Group in Knoxville, Tenn. In this case, "you would be justified in charging the E/M even though the test was preplanned," she adds.

3. When the office visit is solely to convey test findings, you should not bill an E/M code for the visit, regardless of the date of service.

If, for example, a patient has an echocardiography on Monday and your cardiologist has him come in on Wednesday to discuss the test results, do not submit any charge. Communicating test findings is included in the payment for performing the test.

If the test is positive, and the patient comes in for more extensive evaluation in light of the test findings, such as a more focused exam and further diagnostic testing, however, you can bill for the office visit. But the cardiologist must have clearly documented the separate service that he provided in addition to discussing the findings. No modifier is necessary, but the documentation must support the level of service reported. To bill an E/M in this situation, the physician would have to make perfectly clear what he discussed, the exam, medical findings that ensued, and decision-making, McKee says.

Example: Many physicians document the chief complaint as "test results returned" and address little, if anything, in addition to the test findings in their office visit note.

If the note simply states "F/U Echo" and offers no other signs or symptoms, you would not be able to bill an E/M because it would not meet medical-necessity guidelines, andskroener says.

Caution: "Don't bill follow-up if you simply review the test results with no additional workup or pending issues. And no matter what the circumstances, your documentation must support the services provided," Landskroener says.

The bottom line: Use caution when billing E/M on the same day as testing because your modifier use will be scrutinized, Landskroener and McKee say. Practices should develop policies concerning this so physicians will have guidelines to follow to help them decide how to report E/M services on the day of a test, McKee adds.