Cardiology Coding Alert

Reader Question:

Bill Prolonged Services for Ibutilide Infusion

Question: How should I report an IV infusion of Ibutilide for a patient referred to our cardiologist from a family practice physician? Our cardiologist performed the infusion in the hospital. Thirty minutes after the infusion, the patient converted to normal sinus rhythm.
Also, our physician documented 70 minutes spent on the infusion. Should we add an hour of prolonged care to the consultation?

Wisconsin Subscriber

Answer: Pharmacologic, or chemical, cardioversion is a relatively new procedure that usually takes place in the acute-care setting as you've described. The American College of Cardiology (ACC) advises that you can't bill for the infusion therapy, which is a facility rather than a physician charge and is included in the E/M services.
If the physician documented that he spent 70 minutes with the patient, you might be able to bill the prolonged service code (99358). But you will need to determine the nature of the referral. In this situation, assuming the physician spent 70 minutes in face-to-face or unit/floor time and he spent most of that time in counseling or coordination of care, you would bill the highest-level subsequent hospital care code (99233). You could also report the prolonged service care code (99358) because the unit/floor time was at least 30 minutes more than the typical time the physician spends providing subsequent hospital care under 99233 (35 minutes).
If your physician provides consultation services, you could bill only a level-three hospital consultation (99253). The reason is that the usual amount of time associated with this service is 55 minutes, so you would not bill for prolonged care.
If you review the documentation and discuss the case with the physician, however, you will most likely find that, although the infusion may have lasted 70 minutes, nursing staff, rather than the physician, supervised the infusion. Therefore, the prolonged service may not be billable, and you would have to look at the documentation to see which level of subsequent hospital care it supports.
When chemical cardioversion takes place in the physician's office, you can use 90780 (Intravenous infusion for therapy/diagnosis ... up to one hour). In addition, you should report the name and dosage of the drug using the HCPCS level II code as appropriate. Several drugs are available for use, including Amiodarone (J0282), Procainamide (J2690), and Ibutilide (J1742).