• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Separate procedures at different hospitals

Create Wiki
J

Jim Pawloski

True Blue
Messages
1,747
Location
Ann Arbor
Best answers
2
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 Pawloski said:
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
Click to expand...

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 :)
 
dpeoples said:
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 :)
Click to expand...

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:)
 
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.
 
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.
 
You must log in or register to reply here.
Top