Cardiology Coding Alert

CPT 2002 introduced a pair of new E/M codes to report critical care services provided by the cardiologist during transport from one facility to another. Although Medicare does not recognize these codes and instructs physicians to use existing critical care codes instead, the new codes provide more accuracy when cardiologists bill private carriers that recognize them, says Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan. The two codes are: 99289 Physician constant attention of the critically ill or injured patient during an interfacility transport; first 30-74 minutes +99290 each additional 30 minutes (list separately in addition to code for primary service). According to CPT, these codes should be used to report direct, face-to-face care by the physician only. Using the Time-Based Codes Like the critical care codes (99291-99292), the transportation codes are time-based, Vendegna says. You should report the first 30 to 74 minutes of time spent in direct, face-to-face contact with the patient during transportation using 99289, whereas 99290 should be used for any subsequent time that takes at least 30 minutes. If the transportation takes less than 30 minutes, another E/M code (not critical care) must be reported.

Note: Because CPT instructs physicians to report 99290 in 30-minute increments, this code may need to be reported more than once, either by listing the code multiple times or by listing the increments in the units box of the CMS 1500 claim form.

To correctly bill time-based codes, you must monitor and document the amount of direct, face-to-face time the cardiologist spends with the patient during transport, Vendegna says. At least half the time specified in any time-based code must be documented. That means that when billing 99289 (one hour), the physician's notes must describe at least 30 minutes of face-to-face care. Similarly, at least 15 minutes must be documented for each (30-minute) unit of 99290. Although not required, start and stop times should be included, whenever possible. According to CPT, the following should not be considered when determining how to code such services appropriately: Procedures performed by other members of the transporting team Procedures or services performed by the cardiologist before transport Separately payable procedures or services performed during transport (these include most services other than routine monitoring evaluations, such as heart rate, respiratory rate, blood pressure and pulse oximetry) Physician-directed care by telephone (CPT states this service may be reported with code 99288 [Physician direction of emergency medical systems (EMS) emergency care, advanced life support], butMedicare's fee schedule maintains this is a "bundled" code, i.e., always part of another procedure.) The time spent performing any of these procedures or services should not be included when calculating the amount of time involved in the transport of [...]