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Cardiology Coding Alert

You Be the Coder:

CHF Evaluation With Echo

Published on Tue Jul 01, 2003

Question: What are the correct codes to use in this scenario: An established patient calls to report to a nurse of increasing shortness of breath (786.05), weight gain (783.1), and cough (786.2). The physician examines the patient and orders IV Lasix 40 mg SIVP now, 20 meq KCL now, and basic metabolic panel to be sent to the lab. He also orders an echocardiogram, which is done the same day. The cardiologist reviews and interprets the test then discusses the results with the patient. The patient is scheduled for a one-week follow-up with the cardiologist. One to two days later, the nurse calls the patient at home to inquire about the patient's response to the in-office IV therapy and the lab results.
     
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Answer: For the established patient visit, report the appropriate code from the 99211-99215 series. You determine correct code selection for the patient visit according to medical necessity and documentation of the key components for this established patient. Because the physician performed other procedures during the encounter, 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 designate that the visit was a separate and identifiable service.
 
If the physician documents a congestive heart failure diagnosis, report the appropriate ICD-9 code from the 428.x series.
 
Report the echocardiogram using a code from the 93307-93308 series. If the physician also performed Doppler and color flow studies, and the echo report documentation includes data from these studies, use add-on codes +93320 (Doppler echocardiography, pulsed wave and/or continuous wave with spectral display [list separately in addition to codes for echocardiographic imaging]; complete) for the Doppler and +93325 (Doppler echocardiography color flow velocity mapping [list separately in addition to codes for echocardiography]). (See the article on Doppler and color flow reports in this issue.)
 
Use 36000 to report the IV access. In addition, report HCPCS code J1940 (Injection, furosemide, up to 20 mg) x 2 units for the IV Lasix because the code description specifies 20 mg and the procedure required 40 mg. Thus, you would need to report two units. You would not report the 20 meq KCL since this is excluded from coverage because the patient can self-administer the drug. (For more information on this, see the Medicare Carriers Manual, section 2049.2.)
 
You would report the physician's re-evaluation after the IV with the initial E/M code. The nurse's telephone call one to two days after the procedure is also included in this initial workup.

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