Wiki Separate procedures at different hospitals

[Jim Pawloski]

Hello everybody!,

I have a question for everybody. A patient has a heart cath at one hospital, and is transferred to a different hospital for a cardiac interventional procedure. Doctor states that information in the interventional report, and what was found in the diagnostic procedure. Do you code for a repeat diagnostic exam, and the intervention, or code just the interventional performed (PTCA or Stent).

Thanks,
Jim Pawloski, CIRCC

 

[dpeoples]

Hello everybody!,

I have a question for everybody. A patient has a heart cath at one hospital, and is transferred to a different hospital for a cardiac interventional procedure. Doctor states that information in the interventional report, and what was found in the diagnostic procedure. Do you code for a repeat diagnostic exam, and the intervention, or code just the interventional performed (PTCA or Stent).

Thanks,
Jim Pawloski, CIRCC

Jim,
If the diagnostic heart cath at hospital #1 is insufficient for the intervention at hospital #2, you can bill for another as long as the physician documents the medical necessity (previous cath insufficient, patient condition has changed etc). Otherwise, IMO, you should not bill for a second diagnostic heart cath.

HTH

 

[Jim Pawloski]

Jim,
If the diagnostic heart cath at hospital #1 is insufficient for the intervention at hospital #2, you can bill for another as long as the physician documents the medical necessity (previous cath insufficient, patient condition has changed etc). Otherwise, IMO, you should not bill for a second diagnostic heart cath.

HTH

Thanks Danny for your response. I audit a cath lab, and they had questioned me about patients who either had a diagnostic cath on one day, and the intervention on the second day, why I had credited the second heart cath. There was no mention of a change of status on the patient. They billed for a diagnostic heart cath along with the intervention, so I credited the diagnostic part of the bill. I wanted a second opinion on this issue.

Thanks again,
Jim Pawloski, CIRCC

 

[carolhodge]

I've run into this situation before too. I'm just curious, was the cath and the stent performed by the same physician or different physicians? I worked for a group where the docs had priviledges at multiple hospitals.

 

[twizzle]

Unless the patients' condition has changed significantly, in other words worsened or a new Dx is available necessitating a repeat cath, you would not bill the cath performed concurrently with the intervention, just bill the intervention at the second hospital.