by Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC KGG Coding and Reimbursement Consulting, LLC
I’m working with two different cardiovascular group practices right now – and they both have an incorrect understanding of coding diagnostic caths with an intervention. One practice ALWAYS codes the diagnostic with the intervention, and the other practice NEVER does. This is not an ALWAYS or NEVER situation.
Per CPT, a diagnostic coronary or peripheral angiography can be coded on the same day as an intervention if:
1. No prior catheter-based study is available, a full diagnostic study is performed, and a decision to intervene is based on the diagnostic angiography, or
2. A prior study is available, but as documented in the medical record:
a. The patient’s condition with respect to the clinical indication has changed since the prior study, or
b. There is inadequate visualization of the anatomy and/or pathology, or
c. There is a clinical change during the procedure that requires new evaluation outside the target area of intervention.
For example, a friend of mine had a cardiac cath last week – they could see that she would need stents, but because of some issues with contrast, the cardiologist decided that he needed to wait a week to perform the angioplasty with stents. On the second procedure, even though they may have performed a diagnostic study, it would not be billable UNLESS there had been a change in her condition. (Thankfully, there wasn’t, and the second procedure went beautifully, and she’s doing great!)
On the other hand, a patient with chest pain and other risk factors undergoes cardiac cath – the cardiologist notes the blockage and is able to perform angioplasty at the same session. He documents a complete diagnostic study and notes that he did not have a previous catheter-based study. It would then be appropriate to code for both the diagnostic study with modifier 59 and the angioplasty.
As for my clients, one is creating potential liability by always coding for something that is not documented and may not be true. The other client is missing revenue for something that they could legitimately and correctly code for.
Gotta know those CPT guidelines!
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Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC KGG Coding and Reimbursement Consulting, LLC Kim Huey is an independent coding and reimbursement consultant, providing audit, training and oversight of coding and reimbursement functions for physicians. Kim completed three years of pre-medical education at the University of Alabama before she decided that she preferred the business side of medicine. She completed a Bachelor’s degree in Health Care Management and went on to obtain certification through AAPC and AHIMA. Recognizing the important position of compliance in today’s environment, she has obtained certification as a Certified Professional Compliance Officer and has earned a Master of Jurisprudence in Health Law. Kim has authored numerous articles, spoken at local, state and national conferences, and presented audioconferences related to the business side of medicine. Kim has worked with providers in virtually all specialties, from General Surgery to Obstetrics/Gynecology to Oncology to Internal Medicine and beyond. Kim can be reached at [email protected]