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Heart Cath

  1. Default Heart Cath
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    A colleague has asked me a question that I am not able to answer as I have no billing experience with Hearth Catheters. Can someone please comment on this question?

    >>Does it make sense that an outpatient, diagnostic heart catheter lab would have 1,327 "patient visits" in a 12-month period and, yet, the hospital that has entered into a joint-venture with that lab reported 5,006 "procedures" performed at that lab during the same 12-month period?

    Background:

    A local not-for-profit, full service, hospital entered into a joint venture with two physician groups in 2007. Group A and Group B. Prior to the joint venture (and since then), Group A has operated a diagnostic cardiac cath lab at a facility several miles from the Hospital.

    On its financial documents, the Hospital reported 3,268 catheter procedures in 2006, 5,161 procedures in 2007 and 9,424 procedures in 2008.

    When questioned about this apparently nearly three-fold increase in caths in three years, the Hospital said the bulk of the increase resulted from the mid-2007 joint venture with Group A's single heart cath lab.

    When questioned how a single diagnostic lab could add so much to the hospital's total cath figure (the hospital has four outpatient cath labs), Group A said they were not required to release figures (being completely private); however, after a bit more prodding, they said they had done about 1,327 caths in 2008. Not 5,006 as apparently reported by the Hospital.

    When questioned, "Why did you report 5,006 caths" from Group A's lab in 2008 when Group A reports doing just 1,300?", the Hospital said Group A, being an outpatient facility, uses a different method of counting heart caths.

    The Hospital said Group A counts "patient visits" while the Hospital counts "procedures" or "occurrences of service." Asked to explain the difference, the Hospital said, if a diagnostic cath involves checking 2 arteries, 2 "procedures" or "occurrences of service" will be recorded during that single "patient visit."

    Despite this explanation, three health care professionals (with experience with heart caths and billing) I've spoken with said it sounds odd that 1,300 "patient visits" would equate to 5,006 "procedures." That's why I am still trying to get to the bottom of this. >>


    Thank you.
    Cyndee Weston, CPC, CMC, CMRS
    American Medical Billing Association
    www.ambanet.net/AMBA.htm
    AMBACode Coding Software
    http://www.ambacode.net
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  2. #2
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    Quote Originally Posted by cyndeew View Post
    A colleague has asked me a question that I am not able to answer as I have no billing experience with Hearth Catheters. Can someone please comment on this question?

    >>Does it make sense that an outpatient, diagnostic heart catheter lab would have 1,327 "patient visits" in a 12-month period and, yet, the hospital that has entered into a joint-venture with that lab reported 5,006 "procedures" performed at that lab during the same 12-month period?

    Background:

    A local not-for-profit, full service, hospital entered into a joint venture with two physician groups in 2007. Group A and Group B. Prior to the joint venture (and since then), Group A has operated a diagnostic cardiac cath lab at a facility several miles from the Hospital.

    On its financial documents, the Hospital reported 3,268 catheter procedures in 2006, 5,161 procedures in 2007 and 9,424 procedures in 2008.

    When questioned about this apparently nearly three-fold increase in caths in three years, the Hospital said the bulk of the increase resulted from the mid-2007 joint venture with Group A's single heart cath lab.

    When questioned how a single diagnostic lab could add so much to the hospital's total cath figure (the hospital has four outpatient cath labs), Group A said they were not required to release figures (being completely private); however, after a bit more prodding, they said they had done about 1,327 caths in 2008. Not 5,006 as apparently reported by the Hospital.

    When questioned, "Why did you report 5,006 caths" from Group A's lab in 2008 when Group A reports doing just 1,300?", the Hospital said Group A, being an outpatient facility, uses a different method of counting heart caths.

    The Hospital said Group A counts "patient visits" while the Hospital counts "procedures" or "occurrences of service." Asked to explain the difference, the Hospital said, if a diagnostic cath involves checking 2 arteries, 2 "procedures" or "occurrences of service" will be recorded during that single "patient visit."

    Despite this explanation, three health care professionals (with experience with heart caths and billing) I've spoken with said it sounds odd that 1,300 "patient visits" would equate to 5,006 "procedures." That's why I am still trying to get to the bottom of this. >>


    Thank you.

    I am not sure what question you want answered. I will say that since they report using different methods, then there is nothing odd about it. A patient ecounter at a cath lab can easily result in multiple procedures (CPT codes reported) being performed. For instance, a typical left heart cath will include the following codes: 93510,93545,93556. That is three codes for one encounter and is very conservative.

    If your quesion is how can they report using different methods? Then I suggest that is a business or perhaps even legal question, not a coding question.

    HTH
    Danny L. Peoples
    CIRCC,CPC

  3. Default Heart Cath
    Danni - thank you for trying. Since posting, I have received some additional guidance. I think we narrowed it down to the fact that a heart cath can have multiple procedures performed and until we have more information, we cannot assume there weren't additional procedures performed that related to the heart cath so there could very well have been over 5000 procedures on 1327 patients.
    Cyndee Weston, CPC, CMC, CMRS
    American Medical Billing Association
    www.ambanet.net/AMBA.htm
    AMBACode Coding Software
    http://www.ambacode.net
    2015 AMBA National Medical Billing Conference
    http://www.ambanet.net/2015.htm

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