Cardiology Coding Alert

If your cardiologist administers diagnostic tests to patients with syncope (or "fainting"), a relatively common symptom, you may find it difficult to keep track of the testing regimes he uses. Get the lowdown on all of your cardiologist's diagnostic tests with our expert tips on syncope diagnoses. Begin With History, Exam and ECG "I worked at a practice where they kept receiving denials for running diagnostic tests on syncope patients, with the reason for denial being a lack of medical necessity," says Heather Corcoran, manager at CGH Billing Services in Louisville, Ky. "But the fact of the matter is that syncope does have risks." The potential for serious injury particularly affects the elderly as well as patients in high-risk environments (pilots, athletes, commercial truck drivers, etc.). "So more and more carriers are paying for diagnostic testing when syncope is the main symptom," Corcoran adds. All patients with syncope (780.2, Syncope and collapse) require a careful history, physical examination, and routine 12-lead echocardiogram, because these key elements help the physician determine whether the patient requires additional diagnostic testing. Cardiologists will investigate whether syncope relates to arrhythmias, changes in blood pressure, valvular heart disease or cerebrovascular disease, says Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C. 1. Does the Cardiologist Suspect Organic Heart Disease? If the cardiologist knows or suspects that the patient has organic heart disease (429.9, Heart disease, unspecified), he often starts by performing an echocar-diogram or an exercise stress test to help evaluate the structure and function of the heart and also to quantify the degree of heart disease.

Cardiologists use electrocardiograms (93000, Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) as a good baseline-screening test to help assess patients with known or suspected coronary artery disease and or arrhythmias. Routine exercise treadmill testing (93015, Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report) assists the physician in determining whether the patient has exercise-induced arrhythmias, Williams says. Second-Tier Tests Include EPS, Holter Monitor If ECGs, echoes, and stress tests return positive results, your cardiologist may order subsequent testing including the following: When the patient's symptoms suggest arrhythmic syncope, cardiologists sometimes recommend that patients wear a 24-hour Holter monitor (93224-93237). This test pays about $285 based on national averages. Loop monitoring (93268-93272) may be a reasonable alternative for patients with recurrent syncope and a normal heart. Code series 93600-93660 describes the arrhythmia induction, mapping and ablation procedures that cardiologists perform in intracardiac electrophysiologic studies (EPS). These expensive and invasive studies use electric programmed stimulation and monitoring to diagnose "conduction abnormalities which may lead to slow [...]