electrophysiology in a cardiologist office

[cpctheri10]

Our interventional cardiology office recently acquired an electrophysiologist. Are his first visits with an established patient considered new patient or established patient since he is in a subspecialty of cardiology?

 

[Cyndi113]

First make sure that his NPI specialty is EP and that your office has him contracted as an EP. If all of that is done, patients would be considered NP for him.

 

[j.monday7814]

thats true for most insurances, Medicare recognizes EP as a sub-specialty but we have found that a couple of our payers here do not recognize EP as a sub-specialty so check with your payers too

 

[kurhahn]

EP - Cardiologist referrals, does it work both ways?

I understand if one of our cardiologists refers to our electrophysiologist, that this is a new patient for the EP, but what about cases where our EP may admit a patient to the hospital (because she is the physician on call from our group at the time) for a diagnosis such as chest pain, and determines the patient needs a heart cath, so refers the patient to one of our invasive cardiologists. Can the regular cardiologist charge as a new patient or consult, referred by the EP??? Thank you for any input!

 

[Cyndi113]

As long as the cardiologist has not seen the patient in 3 years then yes.

 

[kurhahn]

more questions about EP/Cardio collaboration

Thanks for the response^. We still have a lot of questions about billing properly when our EP sees cardiology patients. In our practice we have mostly interventional cardiologists, but we also have one non-interventionalist (echo specialty) and one EP (she doesn't do any coronary or vascular interventions, only EP procedures. She does though, share call with all of our other cardiologists. A particular instance, Dr. A (interventional cardiologist) admits a patient on Thursday for an acute MI; and sees the patient Thursday and Friday. Dr. EP (our electrophysiologist) is the doctor on call for the weekend, so follows the patient on Saturday and Sunday. Dr. A goes back to following the patient on Monday. on Tuesday, the patient develops a-fib, for which Dr. A asks Dr. EP to consult. So for Tuesday, we have a follow-up visit charge from Dr. A, and a "consult" charge from Dr. EP (even though we have already billed 2 follow-up visits under her ((the weekend)). After this, both physicians may follow the patient for a few days, and both submit charges. Is this correct? I know this is a lot of info, please ask me to clarify or for more information if necessary or it helps to get an answer. We are really struggling (as coders) wanting to be doing this correctly. Please include any information available about how a physician is contracted by our hospital, because we don't (as coders) know anything about this. Thanks so much!

 

[kurhahn]

Another question. Our EP puts a Reveal implantable loop recorder in a patient for syncope on Thursday. On Friday, their regular cardiologist discharges them. Can we charge for this discharge (while under the global period of the ILR) because it is by the "cardiologist", not the EP? Thanks

 

[rebeccadyke84]

Global discharge

Another question. Our EP puts a Reveal implantable loop recorder in a patient for syncope on Thursday. On Friday, their regular cardiologist discharges them. Can we charge for this discharge (while under the global period of the ILR) because it is by the "cardiologist", not the EP? Thanks

Hello,
My understanding with the global issue is if they discharge the patient only because the patient was there for the procedure then it will fall under the global rule. If they also were seeing the patient for other reasons other than the procedure, I would give them the discharge.
If someone disagrees, please let me know.