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Coding and Practice Management Information
We are implementing a cardiology practice managers network. Please include your practice manager's information today.
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Here are some coding questions from your colleagues:
Q: We have been using the J0150 code when billing Adenosine fore Adenosine-Thallium stress tests. When billing this, we billed in 6 mg increments. I recently go information stating we should be using the J0151 instead. My question is - should we bill this as 1 unit or continue using multiple units in 6 mg increments?
A: You are correct. Medicare changed the code they are covering from J0150 to J0151. You will code multiple units using 6 mg increments.
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Q: This is regarding peripheral cardiology: are the codes 75710 and 75716 used for the pre-procedure imaging? Our physician usually does the pre-pictures one week prior to the intervention. So he would not charge for this. The radiologist does. Are the codes 75710 and 75716 used only by the radiologist?
A: The codes 75710 and 75716 are not just for radiologist use. If the cardiologist who is performing these services is the one who is interpreting the images injected, then hen/she can bill both for the cath placement and for the S&I code. For example, if your physician says he performed an angiography of the right common iliac from a contralateral femoral puncture, that would be a 1st order cath code 36245, and then the S&I code 75710. (If an ipilateral approach, meaning direct stick from the same side of the body) then the codes 36140 and 75710 can be coded. Whenever you are performing peripherals, the insurance carrier expects to see a cath code and a corresponding S&I code.
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Q: When the cardiologist performs a left heart catheterization, can he also charge for a 36200 and 75625 or should he be charging a 93544?
A: When your doctor performs a left heart cath and images the aortic root, then the injection code 93544 is added. When the doctor says he did an aortic flush, from a high stick and this was from a pullback into the aorta with no further advancement of the cath, then the codes 36200 and 75625 can be added. Typically, many carriers do not want to pay for the 36200 when billed with the 93510-26 code. But documentation is the key!
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Q: Code 93624 is becoming a huge problem. I need to know the exact instances I can bill for it. The docs do EPS & RFA--can I bill 93624 as well? The CCI says no--please help. The claim I have is billed with 93620, 93623, 93624--can they be billed together?
A: Regarding the coding and denials of 93624, this code is a component code of 93621 & 93620. So I am not finding an appropriate use of the code. It is bundled into all of the EP studies performed.
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Q: Procedure is Rotoblator of LAD. No specific code to find. Only code I can find is 93799 which is unspecified. Do you know if there is a more specific code to use? (DX is 413.0)
A: Rotoblator is a brand name for an atherectomy. The code you want is 92995 for initial vessel and 92996 for each additional vessel.
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Q: Is it appropriate to bill an initial EP 93620-26, RFA 93651 and follow-up EP 93624-26 together when all are performed on the same day? Isn't 93624-26 a component of 93651?
A: The code 93651 INCLUDES the code 93624 because the wording says "singly or in combination." The NCCI edit also has it bundled. Only code the 93620 and the 93651 for all studies in one day.
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Q: When an office that sends its lab work to an outside lab draws blood on a Medicare patient, what can they bill? I am under the impression that you can bill for the venipuncture but not the actual lab test. If this is the case, shouldn't the outside lab bill the patient and not the office? Is this the same with private insurance?
A: You are correct that if you take a blood draw for the labs then you can only bill for the venipuncture. Once the lab you use processes the lab work and bills for it, THEY are the ones who balance bill the patient any services not covered. If you process the lab work in your office (some offices have the labs set up in the back), then you can bill the lab/path codes.
The Ohio Chapter of the American College of Cardiology (OH-ACC) and McVey Associates, Inc. (McVey) have made every attempt to ensure that the information given is suitable and appropriate. The information was designed to be accurate and authoritative to the subject matter covered and question(s) as delivered. Every attempt was made to have the information contained herein to be current to the best of our understanding as to the date it was provided, and could be subject to change in interpretation by the insurance carriers at anytime. This information is given with the understanding that the OH-ACC and McVey are not engaged in rendering legal, billing or accounting services. If legal or other expert advice is required, the services of a competent professional person should be sought so that all facts and circumstances have been thoroughly research to befit the exact situation.
The OH-ACC and McVey disclaim the liability or responsibility for the results or consequences of any actions taken in reliance on the statements, opinions, or suggestions of this information. The OH-ACC and McVey will not be liable to any individual or entity for any losses or damages that the use of this information may occasion.
Another resource for you: American Academy of Professional Coders