Cardiology Coding Alert

A physician or qualified nonphysician who performs the complete ECG service, in addition to the physical, would report both G0344 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment) and G0366, according to the Nov. 15, 2004, Federal Register.  

Remember: Medicare won't pay for G0366 and G0367 when the physician performs the services in the facility setting, the Register states. The reason is these two codes include the technical component of the test. In a facility setting, you should not report the technical component of the service, just the professional component (G0368).

NCCI also applies edits to the following traditional ECG codes, which prevent you from reporting a diagnostic ECG performed to assess symptoms/signs along with the one-time screening ECG: 

Note: These edits are listed as mutually exclusive procedures, which means that practitioners cannot reasonably perform these procedures together. These edits have a modifier indicator of "1" which means you're permitted to use a modifier to bypass the bundle. But keep in mind that you must meet the criteria of modifier -59 (Distinct procedural service), says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver. Otherwise you cannot separate the services. In other words, you should use modifier -59 only for procedures or services that you would not normally report together, but are appropriate under the circumstances.

If you report them together without the appropriate modifier, carriers will only reimburse the code listed in the first column (the G codes) and deny the codes listed in the second column (93000-93010 and 93040-93042).

HCPCS Giveth, NCCI Taketh Away

In addition to the ECG changes, NCCI applied an overwhelming number of edits with injections and/or infusions at the time of other services. HCPCS 2005 introduced codes G0353 (Intravenous push, single or initial substance/drug) and G0354 (... each additional sequential intravenous push) to cover IV pushes, but NCCI has bundled them into the codes that you would have otherwise reported them with.

For example, if your cardiologist performed a nuclear imaging procedure (78460-78483) and you want to report G0354 in addition to that code, you'll have to show medical necessity and append a modifier, such as modifier -59 (Distinct procedural service), to bypass NCCI 11.1's "standard of medical/surgical practice" edit. This goes for stress test codes 93015-93018 and heart catheterization codes 93501-93562. These join a similar set of edits already established in NCCI that bundles code G0353 (the initial injection code) into the same codes.
 
Coding tip: You should report an additional E/M code only when the patient sees the physician, not when the patient presents to the nurse just for an injection, says Kristi White, CPC, a coding and reimbursement specialist in Illinois.