Cardiology Coding Alert

Reader Question:

Catheter, PTCA/Stent Procedures

Question: Which codes and/or modifiers should I use when one cardiologist performs a catheter and calls in another to do an angioplasty and stent procedure? Both physicians are billing under the same Tax Identification Number for the same hospital session. I seem to be doing something wrong since the catheter reimbursement often is reduced or denied outright, while the angioplasty/stent is fully reimbursed. What do you suggest?

Anonymous VT Subscriber

Answer: Cardiac catheterization is a diagnostic procedure, while angioplasties and stents are considered to be therapeutic interventions, says Stacey S. Elliott, CPC, business office manager and a practice coder with COR Healthcare Medical Associates, an 11-cardiologist practice in Torrance, CA. When a patient is taken to the cath lab, it is not uncommon that one physician performs the cardiac catheterization and then another cardiologist will follow with the interventional procedures on the same day. Even if the second physician does not perform the procedures immediately after the catheterization is done, the sheaths are likely to be left in place until the second physician performs the angioplasty/stent, Elliott says.

When billing these procedures, some Medicare carriers automatically reduces the cardiac catheterization by 50 percent and will add modifier -51 (multiple procedures) when performed the same day as a therapeutic procedure (such as a stent or PTCA), even though CPT 1999 specifically states that heart catheterizations (93501-93556) are exempt from modifier -51. You should never bill your catheterization codes with modifier -51 or your reimbursement may be even further reduced by some Medicare carriers and other third-party payers.

The best way for two physicians in the same practice to report these procedures is to bill them on the same claim, she says. The stent or PTCA would be listed as the primary procedure on the claim form, followed by the heart catheterization (93501-93556). Each physicians Medicare provider identification number (PIN) would be reported in block K of the HCFA 1500 form on the same line as the procedure he or she performed.

If the physicians bill their procedures separately, the heart catheterization claim may arrive before the stent/PTCA claim and be incorrectly reimbursed at 100 percent. That could cause a reimbursement problem for the primary procedure, or vice versa if the stent/PTCA arrives first. Billing separately also could prompt subsequent adjustments once both claims are received and may even spur an audit or an accusation of fraud, Elliott says.