http://www.supercoder.com/forum/ Supercoder - Ask an Expert? Forum: Cardiology Coding - Recent Posts en Sun, 12 Feb 2012 11:58:48 +0000 http://www.supercoder.com/forum/topic/a9505#post-11335 Fri, 10 Feb 2012 19:38:50 +0000 lawrence kanter 11335@http://www.supercoder.com/forum/ <p>I Do not understand the answer! </p> http://www.supercoder.com/forum/topic/a9505#post-11330 Fri, 10 Feb 2012 18:07:06 +0000 lawrence kanter 11330@http://www.supercoder.com/forum/ <p>Medicare, here in florida have been denying cpy code A9505 with adjustment code N362, which means exceeds maximum units per day. we have always used 1 unit at 100.00 and we use 5 units(500.00) now, as of 01/01/12 it is being denied, I called the local medicare and the woman answering the phone told me that is was an unpublished edit that was activated 01/01/12, but she could not tell me how many units i can use or where i can find the answers to this questions, oh yeah, she said i could appeal it or make corrections and re-file but she could not tell me how many units are exceptable now, anyone have any answers,please help!!! Desperate!! </p> http://www.supercoder.com/forum/topic/iliac-artery-angiography#post-11316 Fri, 10 Feb 2012 06:37:35 +0000 Nancy Kim 11316@http://www.supercoder.com/forum/ <p>My physician is planning to perform left iliac artery angiography followed by stent placement. I need cpt codes to obtain preauthorization from patient HMO. Please let me know asap. </p> http://www.supercoder.com/forum/topic/stress-test-interpretation-only#post-11310 Thu, 09 Feb 2012 22:50:56 +0000 Sanjit Mishra 11310@http://www.supercoder.com/forum/ <p>Basically, the ordering physician is responsible for the reason for which he ordered for the Stress test. The findings and diagnosis are not what can be in any way a logical, but if mapped with reason for medical exam also, it gives complete support to reimbursement. CPT 93018 is used for supervision and interpretation. So, the additional part included is supervision. </p> http://www.supercoder.com/forum/topic/av-optimization-echo-for-biv-icd#post-11301 Thu, 09 Feb 2012 20:17:44 +0000 Deborah Marsh 11301@http://www.supercoder.com/forum/ <p>I think you're on the right track. My understanding is this examination does not evaluate or document the attempt to evaluate ALL structures that comprise a complete echocardiogram exam. The CPT codes most likely to apply (depending on documentation, of course) are 93308-26, 93321-26, 93325-26, and 93288-26. </p> <p>Here are some additional resources to consider:</p> <p>Optimization with Echo:</p> <p><a href="http://www.eplabdigest.com/articles/Top-Ten-Regulatory-Landmines-EP?page=3" rel="nofollow">http://www.eplabdigest.com/articles/Top-Ten-Regulatory-Landmines-EP?page=3</a><br /> The above May 2010 article by Jim Collins indicates “Reporting diagnostic echocardiography for AV optimization” is a top trouble spot. You should determine whether the echo meets the payer’s definition for medical necessity before coding it. </p> <p><a href="http://www.bostonscientific.com/templatedata/imports/HTML/CRM/Reimbursement/pdf/C5-473-0609_CRT-P_Coding_Overview.pdf" rel="nofollow">http://www.bostonscientific.com/templatedata/imports/HTML/CRM/Reimbursement/pdf/C5-473-0609_CRT-P_Coding_Overview.pdf</a><br /> For CRT-P AV Optimization with Echo, the above manufacturer document suggests choosing the appropriate echo code from 93306-93308 (add 26 as appropriate) and 93321 or 93325 (again adding 26). The pdf also suggests reporting the appropriate reprogramming code, such as 93281-26. </p> <p><a href="http://www.medtronic.com/wcm/groups/mdtcom_sg/@mdt/@crdm/documents/documents/echocy2011200802800een.pdf" rel="nofollow">http://www.medtronic.com/wcm/groups/mdtcom_sg/@mdt/@crdm/documents/documents/echocy2011200802800een.pdf</a><br /> For the transthoracic echo used for AV optimization, the above Medtronic document lists echo codes similar to the Boston Scientific list.</p> <p>Regards,<br /> Deborah Marsh, JD, MA, CPC, CHONC<br /> The Coding Institute </p> http://www.supercoder.com/forum/topic/thrombolysis-coronary-during-lhc-and-intervention#post-11297 Thu, 09 Feb 2012 18:39:34 +0000 Sanjit Mishra 11297@http://www.supercoder.com/forum/ <p>I think for f/u angiography 75898 is the only code be it coronary or not. </p> http://www.supercoder.com/forum/topic/av-optimization-echo-for-biv-icd#post-11292 Thu, 09 Feb 2012 16:23:33 +0000 Jacquelin Underwood 11292@http://www.supercoder.com/forum/ <p>How do I code an echo done at the hospital by cardiologist as an AV optimization study for timing and synchronization of a biV ICD? I think I would need to code a limited echo and device interrogation? Thanks </p> http://www.supercoder.com/forum/topic/aortogram-and-removal-of-foreign-body#post-11284 Thu, 09 Feb 2012 14:33:59 +0000 Lynn Pascoe 11284@http://www.supercoder.com/forum/ <p>37193 is not the correct code for the removal of the "foreign body'. 37193 is specifically for the retrieval of a vena cava filter. I would look at CPT 37203 if the removal was done "transcatheter"<br /> Also, I would not code the 75630 without a modifier, as there is no interpretation of the "Aorta". You might consider using 75630 with a 52 modifier. </p> http://www.supercoder.com/forum/topic/aortogram-and-removal-of-foreign-body#post-11277 Wed, 08 Feb 2012 23:03:17 +0000 Sanjit Mishra 11277@http://www.supercoder.com/forum/ <p>37193 and 75630.<br /> Correctness: Not sure </p> http://www.supercoder.com/forum/topic/stress-test-interpretation-only#post-11270 Wed, 08 Feb 2012 19:35:20 +0000 Jacquelin Underwood 11270@http://www.supercoder.com/forum/ <p>To bill for 93018, does the dr have to include diagnosis or reason for exam even if he is not the ordering physican? Can we use 93018 to bill for just his interpretation? Thanks </p> http://www.supercoder.com/forum/topic/upgrade-single-to-biv-pacer-no-atrial#post-11259 Wed, 08 Feb 2012 17:16:03 +0000 Carol Wright 11259@http://www.supercoder.com/forum/ <p>Sanjit,<br /> I thought you would be interested in this response I received from the HRS:</p> <p>Thank you for your inquiry.</p> <p>A correction will be made in the CPT manual for CPT 33225 parenthetical note. Codes 33228, 33229, 33263, 33264 will be added to the list in which code 33225 may be reported as an add-on. In the case of an upgrade to a CRT device when no right atrial/ ventricular lead(s) are inserted/replaced and only the pulse generator is replaced with a new left ventricular lead insertion, code 33225 may be reported with the pulse generator replacement only codes. Code 33229 for an upgrade from single to multi chamber pacemaker device, the code selection should be based on the final device inserted. </p> <p>An AMA CPT Assistant will be published which will provide documentation of this forthcoming correction. In the interim it may be necessary to work directly the your payer to appeal the claim with this supporting documentation. </p> http://www.supercoder.com/forum/topic/thrombolysis-coronary-during-lhc-and-intervention#post-11258 Wed, 08 Feb 2012 16:39:03 +0000 suzanne cassimore 11258@http://www.supercoder.com/forum/ <p>Is there a code for performing angiography through existing catheter for follow up. Doc did LHC (<code>93458-26</code>), IVUS coronary (+<code>92978</code>) and Thrombolysis coronary <code>92975</code>. Is <code>75898</code> only for peripheral or can be used for coronary as well?</p> <p>Thank you<br /> Julie Agus </p> http://www.supercoder.com/forum/topic/cardiac-cath-question#post-11253 Wed, 08 Feb 2012 15:11:15 +0000 AnnMarie Piscopo 11253@http://www.supercoder.com/forum/ <p>When billing for the LHC 93458, PTCA 92982 &amp; FFR wire flow 93571, does the 93571 require modifier? We receive denials for this code to be billed with a primary procedure &amp; I'm guessing the 93571 is not grouping to the 93458? Cannot seem to get this code paid. HELP! </p> http://www.supercoder.com/forum/topic/aortogram-and-removal-of-foreign-body#post-11251 Wed, 08 Feb 2012 00:20:14 +0000 Jami Deerfield 11251@http://www.supercoder.com/forum/ <p>Need help coding this procedure.</p> <p>Procedure performed<br /> Aortogram<br /> Removal of foreign body</p> <p>The bilateral groins were prepped and draped in standard surgical fashion. Attention was placed to the left groin where under ultrasound guidance, the common femoral artery was accessed. A lot of plaque was noted around the vessel. The access was successful, and a micropuncture 5 french sheath is introduced into the patient's groin. It was noted at the time that the end of the micropuncture wire unraveled and sheared off with the remnant left within the iliac and common femoral artery. At that point a wire was introduced in the UF and an aortogram was performed demonstrating complete occlusion of the right common external iliac vessels with reconstitutin of profunda femoral and common femoral artery through collaterals. The patient's right hypogastric is also out. The pelvis is being fed by a large sacral vessel as well as a diseased left hypogastric. A snare was used to retrieve the foreign body which was successfully retrieved. The patient received no heparin during the procedure. </p> http://www.supercoder.com/forum/topic/93015-circumstances#post-11249 Tue, 07 Feb 2012 22:02:32 +0000 Sanjit Mishra 11249@http://www.supercoder.com/forum/ <p>93015 is the code for performing all components (when physician owns the equipment).<br /> *<br /> 93017 is simply the technical component of the stress test.<br /> *<br /> 93016 and 93018 are the supervision (physician standing and watching the monitor) and interp and report (interpreting the stress results and preparation of the formal report).<br /> *<br /> So basically if a stress is done at the hospital:<br /> Physician bills 93016 and 93018<br /> Hospital bills 93017<br /> *<br /> If done in office and physician owns equipment:<br /> Physician bills 93015 </p> http://www.supercoder.com/forum/topic/assistant-surgeon-1#post-11245 Tue, 07 Feb 2012 21:28:29 +0000 Sanjit Mishra 11245@http://www.supercoder.com/forum/ <p>One who is billing on behalf of Assistant surgeon, will be billing the procedure with modifier 80<br /> Since you are billing only the primary surgeon, so you will only bill the procedure without modifier. </p> http://www.supercoder.com/forum/topic/93015-circumstances#post-11244 Tue, 07 Feb 2012 21:14:00 +0000 Jacquelin Underwood 11244@http://www.supercoder.com/forum/ <p>Would a cardiology office ever use 93015 to code a stress test performed in the hospital with hospital equipment and WITHOUT the cardiologist present? I thought this code was for stress tests performed in the office, not hospital, and that the doc had to be present. I would use 93018 to code his report. Thanks. </p> http://www.supercoder.com/forum/topic/assistant-surgeon-1#post-11224 Tue, 07 Feb 2012 15:34:09 +0000 Jami Deerfield 11224@http://www.supercoder.com/forum/ <p>My doctor did the surgery, but had an assistant surgeon, would I bill with modifier 80, or would the other surgeon bill with it? Or is there another modifier I should use showing there was an assistant surgeon? </p> http://www.supercoder.com/forum/topic/upgrade-single-to-biv-pacer-no-atrial#post-11217 Mon, 06 Feb 2012 21:32:31 +0000 Sanjit Mishra 11217@http://www.supercoder.com/forum/ <p>I think you should bill 33224 in place of 33225, also need to bill along with 33214 </p> http://www.supercoder.com/forum/topic/cpt-code-35301#post-11210 Mon, 06 Feb 2012 18:43:01 +0000 Sanjit Mishra 11210@http://www.supercoder.com/forum/ <p>35301 : you can observe that both endarterectomy and angioplasty included in it.<br /> ICD-9: 433.10 </p> http://www.supercoder.com/forum/topic/upgrade-single-to-biv-pacer-no-atrial#post-11200 Mon, 06 Feb 2012 16:07:03 +0000 Carol Wright 11200@http://www.supercoder.com/forum/ <p>MD placed an LV lead, removed a single pacer generator, placed a BiV pacer generator; connected the existing RV lead &amp; the new LV lead and capped the atrial port.</p> <p>I can't find this combo in the new codes?! Can I bill 33214 and 33225 even though the only new lead placed was the LV lead?</p> <p>TIA,<br /> Carol Wright, CPC </p> http://www.supercoder.com/forum/topic/biv-icd-pulse-generator#post-11191 Mon, 06 Feb 2012 09:32:51 +0000 Sanjit Mishra 11191@http://www.supercoder.com/forum/ <p>Dual Chamber ICD<br /> -----------------<br /> A dual chamber implantable cardioverter defibrillator is a kind of defibrillator implant that uses two sensing leads to function. These two leads are placed in different areas of the heart. One lead is placed in the right atrium (RA) of the heart, and the other lead is placed in the right ventricle (RV). In order to function properly, the defibrillator implant will release a certain amount of electrical energy in the lead connect to the right atrium; shortly after the first lead fires, the second lead connect to the right ventricle of the heart will be sent a certain amount of electrical energy as well. This sequential firing of the two leads, which are placed in two distinct areas of the heart, allow for the heart to beat in a normal rhythm.<br /> *<br /> *<br /> Biventricular Pacing Defibrillator (also called a Cardiac Resynchronization Therapy Defibrillator)<br /> --------------------------------------------------------------------------------------------------<br /> These devices are relatively new and feature two or three leads that are connected to the heart in separate areas. These cardiac regions include the right atrium (RA), the right ventricle (RV), and the left ventricle (LV). Typically, these leads are placed in their appropriate region through the coronary sinus vein. Biventricular pacing also refers to Cardiac Resynchronization Therapy, both of which are a form of pacing therapy that allows your heart to beat normally. In addition, it has been proven to increase patients’ ejection fraction by five to ten percent and higher. This form of cardiac implant is usually combined with a defibrillator as patients who qualify for this type of therapy may also be at high risk of cardiac arrest. </p> http://www.supercoder.com/forum/topic/cpt-code-35301#post-11185 Sun, 05 Feb 2012 15:42:02 +0000 Jami Deerfield 11185@http://www.supercoder.com/forum/ <p>Is angioplasty included with cpt code 35301? If not what code would I use for carotid angioplasty? The procedure is carotid endarterectomy and patch angioplasty. </p> http://www.supercoder.com/forum/topic/biv-icd-pulse-generator#post-11145 Thu, 02 Feb 2012 22:10:16 +0000 Keven Fischer 11145@http://www.supercoder.com/forum/ <p>If a patient has a BiV ICD pulse generator and the leads are placed in the right and left ventricle does this code as a dual chamber ICD? The definition of dual chamber shows it as having a lead in the ventricle and the atrium. </p> http://www.supercoder.com/forum/topic/cardiac-arrest#post-11115 Thu, 02 Feb 2012 16:40:23 +0000 anthony orlando 11115@http://www.supercoder.com/forum/ <p>any takers on this one </p> http://www.supercoder.com/forum/topic/cpt-for-history-physical-done-as-hospital-outpt-followed-by-a-cardioversion#post-11099 Wed, 01 Feb 2012 21:17:52 +0000 Sanjit Mishra 11099@http://www.supercoder.com/forum/ <p>If it is saying "Initial Hospital Care", then it is "outpatient history &amp; physical", but "Inpatient E/M", so coded appropriately as 99223, but "Place Of Service"(POS) should be "21".<br /> You can use modifier 25 with CPT 99223 if you are billing 92960 on same DOS. </p> http://www.supercoder.com/forum/topic/cpt-for-history-physical-done-as-hospital-outpt-followed-by-a-cardioversion#post-11064 Tue, 31 Jan 2012 20:53:23 +0000 Victoria Evenhuis 11064@http://www.supercoder.com/forum/ <p>We've been submitting 99223 as outpt history &amp; physical but Medicare rejected as invalid place of service.As we know its description was Initial hospital care.We want to know the correct cpt especially if there's procedure done the same day e.g.cardioversion, is 92960 correct? What modifier to use?Pls advise!!!!Thank you....... </p> http://www.supercoder.com/forum/topic/cpt-for-office-ekg-technical-component#post-11062 Tue, 31 Jan 2012 20:27:55 +0000 Victoria Evenhuis 11062@http://www.supercoder.com/forum/ <p>Thanks a lot,I appreciate it was a speedy reply&gt;&gt;&gt;&gt;&gt; </p> http://www.supercoder.com/forum/topic/implant#post-11054 Tue, 31 Jan 2012 19:02:49 +0000 anthony orlando 11054@http://www.supercoder.com/forum/ <p>thank you </p> http://www.supercoder.com/forum/topic/cpt-for-office-ekg-technical-component#post-11038 Tue, 31 Jan 2012 15:43:20 +0000 Leesa Israel 11038@http://www.supercoder.com/forum/ <p>For the services your office performs, you should report 93005 (Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report).<br /> *<br /> Although for many codes you would indicate performance of only a portion of the service by appending either modifier TC (Technical component) or 26 (Professional component), that method does not apply for ECGs.<br /> *<br /> Instead, this family of codes provides separate options depending on whether you perform the entire service (93000, ... with interpretation and report), the technical component only (93005), or the professional component only (93010, ... interpretation and report only).<br /> *<br /> Caution: Be sure payer agreements include the component codes (93005, 93010) in the payer fee schedule and not just the global code (93000).<br /> *<br /> Best,<br /> Leesa<br /> *<br /> Leesa A. Israel, BA, CPC, CUC, CMBS<br /> Executive Editor, The Coding Institute<br /> Manager, TCI Consulting &amp; Revenue Cycle Solutions<br /> Email: <a href="mailto:leesai@codinginstitute.com">leesai@codinginstitute.com</a><br /> <a href="http://www.codinginstitute.com" rel="nofollow">http://www.codinginstitute.com</a> </p>