Cardiology Coding Alert

When coding for a cardiologist who is working with another doctor to treat a patient, you'll stand a better chance of getting reimbursement if you code to the highest level of specificity. The more precise the diagnosis code, the more likely you'll be able to show the medical necessity of the care delivered. Medicare defines concurrent care as occurring when more than one provider at a time renders services more extensive than a consultation. Thus, when more than one doctor provides services to a Medicare patient in the hospital, they would meet this definition of concurrent care, says Jim Collins, CHCC, CPC, a coding consultant and compliance officer with Mid-Carolina Cardiology in Matthews, N.C.

Collins stresses that Medicare requires the following criteria for concurrent care claims:

both providers must be actively participating in treatment

the patient's condition must warrant the services of both providers

the services must meet Medicare's definition of "reasonable and necessary." According to Medicare, reasonable and necessary services are "considered under accepted standards of medical practice to be a specific and effective treatment of the patient's condition." If two doctors treating the same patient meet all three conditions, carriers will typically pay both claims if each physician reports a unique diagnosis on the claim, Collins says. "This is the cleanest and most efficient way to obtain reimbursement for concurrent care," he observes. That goes for Medicare and private carriers. (See page 76 for more information on concurrent care claim strategies for Medicare and private payers.) Copycat Codes Could Mean No Payment As a good rule of thumb, you should code to the ultimate level of specificity and certainty, Collins says. "If your provider is consulted for a sign or symptom and he or she makes a definitive diagnosis when taking over a portion of the patient's care, report the definitive diagnosis rather than the sign or symptom. By relying on the diagnosis, you will most likely avoid reporting the same diagnosis code as other providers," he says. For example, if a cardiologist is following a patient who is in the hospital after bypass surgery or valve replacement surgery, the surgeon will use the cardiac diagnosis (e.g., aortic aneurysm, 441.9), says Sandy Fuller, CPC, a cardiology coding and reimbursement specialist in Abilene, Texas.

"In our practice, after the cardiologist does the heart catheterization, he or she withdraws from the case and lets the surgeon take over," Fuller says. The cardiologist provides additional services to the patient only if the surgeon requests that he or she treat a specific problem, such as atrial fibrillation (427.31) or hypertension (402.x). If the cardiologist only provides specific services at the request of the surgeon, this eliminates the concurrent diagnosis [...]