Cardiology Coding Alert

ABNs could be your saving grace--find out how

To report clean claims for your cardiac rehabilitation (CR) services, you'll need the right documents, including the attending physician's script, the supervising physician's signature on exercise sessions, and plenty of support for separate services during rehab sessions.

Stay clear of these four pitfalls, and you'll report CR services correctly every time. Pitfall 1: Professional Services Not Apparent The first step is to make certain that your cardiologist's professional services are apparent to the carrier.   

Here's how: Make sure your cardiologist performs both initial and subsequent services to reflect active participation in the course of treatment. "It's very important that the treating physician provide a written prescription for cardiac rehab services," says Sheldrian Leflore, CPC, a revenue management educator with The Coding Group in Carlsbad, Calif.

Best advice: Before billing 93798 (Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring [per session]), document everything. Getting your CR documentation right will eliminate reimbursement woes. Indeed, Medicare pays about $20 per facility session for 93798, according to national averages in the Physician Fee Schedule--and for a patient on a six-week protocol, this can really add up.

Remember: Cardiac rehab services (93797-93798) have a zero-day global package. To bill for any additional physician services on the same day as cardiac rehab, you do not need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to prevent bundled-service denials.

But some carriers are slow to implement CMS Transmittal 954, released last year. This transmittal instructs you to use modifier 25 only when your cardiologist provides a significant and separately identifiable E/M service on the same day as a procedure that has a global period. (For the exact language, go to www.cms.hhs.gov/transmittals/downloads/R954CP.pdf.) In other words, you may still need to use modifier 25. Bottom line: Check with your payer.

Example: The physician might perform an interim physical exam to assess the therapy's impact and to make sure no adverse events are imminent. In this situation, you would report an established patient office visit (for example, 99213, Office or other outpatient visit for the evaluation and management of an established patient) and the cardiac rehab service (93797-93798). If your payer requires modifier 25, you would append it to 99213. Pitfall 2: Missing Supervising Physician
 
To recoup ethical reimbursement for cardiac rehab services, you have to be very clear about documenting who the supervising physician is.

A CMS official provided Cardiology Coding Alert with the following definition of direct supervision for cardiac rehab services: "It does not require that a physician be physically present in the exercise room itself, provided the contractor [...]