Cardiology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: If a patient (referred by a colleague) is scheduled for a cardiac catheterization and our cardiologist does a full H&P prior to performing the service, can he bill for any type of E/M on the same day as the cath? Furthermore, if the heart cath determines that the patient requires a stent, can my cardiologist bill for the admit and discharge if he dictates both?

Washington Subscriber


Answer: If the heart cath is scheduled which seems to be the case here no E/M service may be billed, says Sandy Rubio, RN, CPC, a cardiology coding and reimbursement specialist in Omaha, Neb., because the medical decision-making that determined the need for the cath has already been performed (apparently by the referring cardiologist).

An E/M service may be billed additionally by the cardiologist who performs the cath only if:

The patient arrives at the hospital and the cardiologist determines that the patient requires an emergency cardiac catheterization. In this case, because the E/M led to the decision to perform the procedure, it is separately payable. Modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) should be appended to the E/M service code.

The patient had other problems either before or after the heart cath was performed.

Rubio also notes that the heart cath has a 24-hour (0-day) global period. This means that if the patient is discharged from the hospital the following day, no discharge should be billed unless the patient needed to be followed for a reason over and above routine follow-up care for the cath (such as hypertension). In that case, modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period) should be appended to the E/M code.