Cardiology Coding Alert

Question: A patient shows up at the office in ventricular tachycardia. After seeing the patient, the cardiologist evaluates and decides to give the patient IV verapamil. The patients rhythm comes back under control. But how do we charge for IV verapamil? Its an unlisted drug even though its 20 years old. Supplies include IV fluid, tubing, leads, tape, gloves, not to mention the original ECG and subsequent rhythm strips (203). It takes 45 minutes to 1 hour of physician time in his office. Are the drug and supplies on us?

Anonymous CA Subscriber

Answer: No. You should be charging for the following:

1. Verapamil. Use HCPCS code J3490. Also bill for the saline with J7040, J7050, or J7030. These drug codes include tubing and needles, so you cannot bill for them separately.

2. ECG. Although the cardiologist may perform more than one ECG, youll only get paid for one of them because the information can be gathered from a rhythm strip. Use 93000 (electrocardiogram, routine ECG, with at least 12 leads). You also can charge for the rhythm strip by appending modifier -59 to 93040 (rhythm strip). Normally, the rhythm strip is bundled into the ECG; however, if the strip is done in a separate session from the original ECG to determine whether the cardioversion is effective, then it is appropriate to append modifier -59 to the rhythm strip. You may justify billing for repeated rhythm strips with proper documentation.

3. E/M code. Bill a level of office visit appropriate for services rendered and documented.

Note: If time is documented, you may be able to charge for prolonged services in addition to the E/M code. Use 99354 (prolonged physician service in the office or other outpatient setting requiring direct patient contact, first hour) and 99355 for each additional 30-minute increment. Remember to include the nurses time as well as the physicians time in calculating the total amount of care rendered.

4. Diagnosis code. Use 427.1 (paroxysmal ventricular tachycardia).

Editors Note: Advice for these questions was provided by Susan Callaway-Stradley CPC, CCS-P, senior consultant for the Medical Group of Elliott, Davis and Co., Augusta, GA, and Ray Cathey, PA-C, president, Medical Management Dimensions, a coding and reimbursement consulting firm in Stockton, CA