Cardiology Coding Alert
Check Payer Rules on EP Specialty Designation
Question: One of our commercial carriers is bundling the EP’s E/M visit with the cardiologist’s even though the patient was seen for distinct reasons. Is there a way to report these for separate payment?
Separate recognition of EP and cardiology visits may be an issue for contract discussion, as well.
Codify Subscriber
Answer: Check to see whether the payer offers guidance on specialty designations. While CMS has distinct specialty codes for cardiac electrophysiology EP (21) and cardiology (06), the private payer may not have adopted that approach.
It’s possible the payer recognizes concurrent care and would allow billing both separately if you appeal with proof that the visits meet the payer’s standards. Be sure to mention that these visits were for distinct reasons.
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