Cardiology Coding Alert

Before you report an unlisted procedure code, check for a better option.

Cardiology is a cutting-edge specialty, and that means CPT^® has to keep up with the constantly changing procedures and services involved. For coders, that can mean having to remember to check Category III code options for the most appropriate code.

Why? Category III codes are temporary codes for emerging services. Using the Category III code allows for the collection of specific data about use, efficacy, and outcomes.

Rule: “If a Category III code is available, this code must be reported instead of a Category I unlisted code,” CPT^® guidelines in the Category III Codes section state. Category III codes often apply to services that payers consider investigational and therefore won’t cover. So if you submit an unlisted procedure code when a Category III code is appropriate, payers may suspect you’re trying to work around noncoverage of the procedure to get paid.

But take heart. Reporting Category III codes helps prove their clinical use, which is one aspect involved in the decision to make them permanent Category I codes.

To help keep your claims accurate, here’s a list of Category III codes that may apply to the services you provide.