Cardiology Coding Alert

Question:

Colorado Subscriber

The key to preventing denials for preoperative electrocardiograms (ECGs) may be reporting both V72.81 (Preoperative cardiovascular examination) and a secondary code that shows why the patient requires surgery.

Trailblazer, your Part B MAC for Colorado, includes this note in its local coverage determination for ECGs (L26535): "V72.81-V72.84* When billing one of these codes, you must also include other ICD-9-CM codes for the medical condition(s) that prompted the surgery or preoperative medical evaluation. The use of these diagnosis codes alone does not establish medical necessity and claims will be denied." (You can search Medicare's coverage database online at http://www.cms.gov/mcd/search.asp.)

Example: Suppose a patient presents with a fractured elbow, and the surgeon wants to schedule the surgery for the next day. The patient requires a preoperative ECG to assess whether he's fit for surgery. The ECG shows normal results. For the ECG diagnoses, report V72.81 and the appropriate fracture code, such as 812.4x (Fracture of humerus; lower end, closed).