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Separate procedures at different hospitals

  1. #1
    Default Separate procedures at different hospitals
    Medical Coding Books
    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

  2. #2
    Location
    Birmingham, Alabama
    Posts
    889
    Default
    Quote Originally Posted by Jim Pawloski View Post
    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
    Danny L. Peoples
    CIRCC,CPC

  3. #3
    Default
    Quote Originally Posted by dpeoples View Post
    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

  4. #4
    Default
    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.

  5. #5
    Location
    Sarasota FL
    Posts
    919
    Default Separate procedures at different 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.

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