Cardiology Coding Alert

Place of service isn't the only sticky wicket CMS addresses in Transmittal 1823.

It also includes which date of service (DOS) to report for an interpretation performed at a later date than the study: "The appropriate DOS for the professional component is the actual calendar date that the interpretation was performed."

Example: The patient has a Holter study (such as 93225, Wearable electrocardiographic rhythm derived monitoring for 24 hours ... recording [includes connection, recording, and disconnection) on April 30, and the cardiologist performs the interpretation (93227, ... physician review and interpretation) on May 2. The DOS for the test is April 30, and the DOS for the interpretation is May 2.

This clarification could prove to be "a thorn in the paw of virtually every cardiology practice," warns Jim Collins, CCC, president of CardiologyCoder.Com in Saratoga Springs, N.Y. Cardiology offices often "conduct diagnostic testing like echocardiograms, nuclear stress tests, and EKGs on one calendar date but do not officially interpret the tests until the next day." To comply with this clarification, practices need to submit two claims "to secure compensation for all diagnostic tests that do not have same-day interpretations," he says. And list the supervising physician as rendering physician for the technical portion of the test and the interpreting physician as the rendering physician for the professional portion, Collins says.

Caution: Collins predicts practices may see denials for duplicate claim submission or for exceeding frequency limitations until carriers update their systems to recognize the multiple claims as being reported for different portions of the same test.