Is Coding Uncertainty Sabotaging Your Cardiology Claims?

Posted on 6 Jun, 2019 |comments_icon 0|By Elizabeth

Get answers to key cardiology reporting questions from cardiology coders like you — and secure full reimbursement for your services.

Uncertain reporting is a wager that could result in substantial reimbursement loss for your cardiology practice. Nonetheless, it happens — a chart comes across your desk that leaves you guessing or debating code options with your colleagues.

If cardiology reporting uncertainty has you concerned about your profit margin, today’s post is for you. Prevent coding errors from siphoning off your hard-earned pay with expert guidance from Meagan Williford, CPC-A, editor-in-chief of TCI’s Cardiology Coding Alert, and cardiology coding veteran, Christina Neighbors, MA, CPC, CCC, member of AAPC’s Certified Cardiology Coder steering committee.

Question 1: Dive into Rules for 2019 Code 33289

I’m not sure that I fully understand the rules regarding code 33289. Can you please explain?

Answer: CPT® 2019 added new code 33289 (Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision and interpretation, and pulmonary artery angiography, when performed).

“Transcatheter implantation of a wireless pulmonary artery pressure sensor (33289) establishes an intravascular device used for long-term remote monitoring of pulmonary artery pressures (93264),” according to the new CPT® guidelines. “The hemodynamic data derived from this device is used to guide management of patients with heart failure.”

Notes under code 33289 instruct you to turn to another new code — 93264 (Remote monitoring of a wireless pulmonary artery pressure sensor for up to 30 days, including at least weekly downloads of pulmonary artery pressure recordings, interpretation(s), trend analysis, and report(s) by a physician or other qualified health care professional) — to report remote monitoring of an implantable wireless pulmonary artery pressure sensor.

Important: You should also never report 33289 in conjunction with catheter codes 36013-36015; angiography codes 75741-75746; fluoroscopy code 76000; right heart catherization code 93451; combined right and left heart catheterization code 93453; catheter placement codes 93456, 93457, 93460, and 93461; catheterization codes for congenital cardiac anomalies 93530-93533; and injection code +93568.

Don’t miss: The 33289 procedure includes right heart and selective pulmonary artery catheterization, placement of the sensor, configuring the sensor pressure ranges (calibration), radiological supervision and interpretation, and angiography (vascular imaging following contrast injection) when performed.

Question 2: Focus on Time Rather Than the Number of Physicians in the Same Group

I am not sure how to code this critical care scenario. Physician A spent 30 minutes with the patient, Physician B spent 20 minutes, and Physician C spent 25 minutes. The physicians are all with the same practice and specialty.

When I added the times together, I coded 99291 and +99292 (total time = 75 minutes). However, my office manager disagreed with the codes I submitted. He thought we should report 99291 and +99292 x 2 (one code for each person) instead. His reasoning was that we can’t add the two times together unless one of the physicians has spent a minimum of 60 minutes with the patient. He also said that if the first physician does not see the patient for 60 minutes, a 99291 would be billed for him and a +99292 would be billed for the second physician even if the two times added together do not equal more than 74 minutes.

Can you advise us on this?

Answer: When your physician provides critical care, the primary code you would report is 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes). You will report this code only once for a patient in a day even if the services have been provided by one physician or more of the same group.

For additional time, you will report multiple units of +99292 (Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes [List separately in addition to code for primary service]), depending on the amount of time that was spent on providing critical care services.

To report either of these codes, you must meet the minimum defined time. Therefore, to code 99291, your physician(s) must have provided critical care for at least 30 minutes. To code the +99292 for each additional 30 minutes, you again must meet this code at a minimum of 15 minutes beyond the first hour.

The example that you have provided has three physicians providing critical care services for a total of 75 minutes. So, you will have to report one unit of 99291 (for the cumulative 60 minutes of initial critical care) and one unit of +99292 (for the next 15 minutes of critical care). Therefore, you are right in the way you have reported the services, and your office manager is incorrect.

Since the three physicians are part of the same group and specialty, they would report their cumulative service as if they were a single physician. The claim can be submitted under the first physician’s ID to satisfy the requirements for the first hour of critical care.

Question 3: Go Beyond Diagnoses for YAG Laser Denial

The cardiologist documented paroxysmal supraventricular tachycardia. How should I report this condition?

Answer: You should report I47.1 (Supraventricular tachycardia) for this condition. Supraventricular tachycardia refers to a faster than normal heart rate that originates in the atria or the atrioventricular node. Paroxysmal means the rapid heart rate happens occasionally.

Included conditions for I47.1 include:
• Atrial (paroxysmal) tachycardia
• Atrioventricular [AV] (paroxysmal) tachycardia
• Atrioventricular re-entrant (nodal) tachycardia [AVNRT] [AVRT]
• Junctional (paroxysmal) tachycardia
• Nodal (paroxysmal) tachycardia.

Don’t miss: A code first note instructs you to sequence tachycardia complicating the following conditions first, followed by I47.1:

• O00.0 (Abdominal pregnancy) through O07 (Failed attempted termination of pregnancy)
• O08 (Complications following ectopic and molar pregnancy)
• O75.4 (Other complications of obstetric surgery and procedures).

Contributing Editor: Meagan Williford, CPC-A

Learn More
Put an end to avoidable denials, needless audit risks, and debilitating payback demands with your monthly subscription to Cardiology Coding Alert. Every issue of this indispensable resource delivers high-impact tips and how-to reporting tutorials to guide you over your reimbursement hurdles and help you conquer the revenue-risking challenges that threaten your claims and compliance success.

The Coders’ Specialty Guide 2019: Cardiology/Cardiothoracic Surgery includes all CPT® and HCPCS codes relevant to cardiology, simple descriptions that explain each code, expert advice for assigning codes, Medicare reimbursement details, diagnosis codes crosswalk, applicable modifiers, CCI edits, global days, code index, hundreds of anatomical illustrations, and more.



Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of telehealth services.

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