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Cardiology Billing Talk

Cardiology Billing Talk . June 2009. Encounters. A number tied to a service code that it meant to represent a separate event in patient care 0-9 Procedures done during the same encounter Less valued code 75%. 03.05A. 03.05A Intensive care visit, per 15 minutes …… .$52.92 NOTE:

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Cardiology Billing Talk

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  1. Cardiology Billing Talk June 2009

  2. Encounters • A number tied to a service code that it meant to represent a separate event in patient care • 0-9 • Procedures done during the same encounter • Less valued code 75%

  3. 03.05A • 03.05A Intensive care visit, per 15 minutes…….$52.92 • NOTE: • 1. Time spent with a patient may be claimed on a cumulative basis per day. • 2. When a consultation is claimed in association with 03.05A during the same encounter, the consultation is considered to occupy the first 30 minutes of time spent with the patient. • 3. Time spent performing procedures should be excluded from the cumulative time spent with the patient per day. • 4. When a procedure and 03.05A are provided during the same encounter, only the greater benefit may be claimed.

  4. Transfer of Care • 03.03AI Transfer of care of intensive care patient ................$ 140.00 • NOTE: • 1. May be claimed on the date of transfer by the receiving physician when assuming responsibility for care of an intensive care patient. • 2. Only one transfer may be claimed per patient, per calendar week, regardless of whether the same or different physician provides the service. • 3. The physician from whom the care is being transferred may claim a hospital visit or intensive care visit, as appropriate, on the day of transfer. • 4. May not be claimed for weekend coverage or within 24 hours of admission to hospital. • 5. 03.05A may be claimed by the receiving physician after 30 minutes of time related to care of the patient has been spent.

  5. Transfer of Care • 03.03D Daily hospital visit (referred patient)...............................…$ 51.25 • NOTE: • 1. Specialist rates are for referred hospital visits only. • 2. A maximum of six level one days may be claimed when the same physician claims a comprehensive visit or consultation on the date of hospital admission. • 3. Only one HSC 03.03D may be claimed per patient, per physician, per day. Special callbacks (HSCs 03.05N, 03.05P, 03.05QA, 03.05QB, 03.05R) may be claimed when the criteria listed under HSC 03.05R are met. • 4. Modifier COMX may be claimed for the management of complex acute care hospital inpatients with multi-system disease. Refer to the COMX modifier definition for clarification regarding the use of this modifier.

  6. Emergency Services • 13.99E Resuscitation, first hour ............................................…$ 353.63 • Each portion of 15 minutes after the first hour (billed as calls for the code – total of 12 allowed)………………………………………………………………………… $ 88.42 • NOTE: • 1. Resuscitation is defined as the emergency treatment of an unstable patient whose condition may result in imminent mortality without such intervention. • 2. May be claimed when this service follows a consultation or hospital visit earlier in the same day as defined under GR 1.19. • 3. Each subsequent 15 minutes is payable at the rate specified in the Price List. • 4. When the condition of the patient is such that further care is provided, either before or after the patient is resuscitated, at a level consistent with the description of HSC 13.99H, 13.99J, 13.99K, 13.99KA or 13.99KB, time spent providing that care may be claimed using these HSCs. Concurrent claims for overlapping time for the same or different patients may not be claimed.

  7. Emergency Services • 13.99J Medical emergency detention time (per 15 minutes…..$ 51.79 • NOTE: • 1. Time may be claimed on a cumulative basis per day (defined as 0001 to 2400), and may include time spent with the patient, review of patient history including diagnostics, review of patient prescriptions and other activities the physician does in relation to the patient's care on the same date of service. • 2. Time spent providing services compensated elsewhere in the Schedule, e.g., family conferences and procedures, may not be included in time claimed for HSC 13.99J. • 3. Supporting information must be submitted. • 4. May be claimed by a physician during the time he/she is medically required to personally and continuously attend and treat an illness or injury of an emergency nature.

  8. Respiratory Codes • 13.62A Ventilatory support, in Intensive Care Unit (ICU) ....…$ 79.37 • NOTE: • 1. Benefit includes endotracheal intubation with positive pressure ventilation, tracheal toilet, use of an artificial ventilator and continuous positive airway pressure (CPAP) through an artificial airway. • 2. May only be claimed for services provided in approved level 2 and 3 and neonatal ICUs. • 3. May only be claimed once per 24 hour period for any ventilated patient, irrespective of the number of physicians providing care. • 4. May not be claimed for the same date of service by the same physician who provides either an anaesthetic or surgical procedure. • 5. May be claimed in association with other ICU services. • 6. Benefits for unscheduled services may be claimed according to GR 15

  9. Respiratory Codes • 10.04 Endotracheal intubation for aspiration of sputum . . ……………………………………………….$ 31.13 • NOTE: May not be claimed with 13.62A. • 10.04B Intubation performed in an emergency room, AACC or UCC . . . ………………… . .$ 106.57 • NOTE: • 1. May only be claimed when performed in an emergency room, AACC or UCC. • 2. May not be claimed in addition to HSC 10.04, 13.99E or 13.99EA when performed by the same physician. • 3. May be claimed in addition to visits or other services provided on the same day by the same physician.

  10. Respiratory Codes • 46.04A Tube thoracostomy – for other than empyema…. $ 82.00 • 46.04B Tube thoracostomy – for empyema or effusion…. $ 107.83 • 46.91 Thoracentesis ……………………………………$ 60.90 • NOTE: • A repeat performed within 31 days is payable at a reduced rate. • Refer to Price List.

  11. After hours Modifiers

  12. Cardiac Codes • 13.72A Cardioversion . . . . . .$ 97.88 • NOTE: May not be claimed with electrophysiology studies. • 49.0 Pericardiocentesis . . . . . . . . . . . .$ 101.74 • NOTE: • If a repeat service occurs within 14 days, benefit will be modified, refer to Price List. • 49.61B Percutaneous insertion of intra aortic balloon pump to include removal ……….. $ 170.30 • NOTE: • When performed in conjunction with other procedures fee will be • modified, refer to Price List. • 49.73A Temporary right heart catheter pacemaker ………………………………….$135.80 • NOTE: • Claims for temporary insertion of a pacemaker in conjunction with other cardiac procedures are included.

  13. Hemodynamic Codes • 49.98B Pharmacological manipulation of physiological function and recording thereof …….$ 78.67 • 49.98C Physical manipulation of physiological function and recording thereof……………. $78.67 • 49.98D Electrical manipulation of physiological function and recording thereof…………….$ 78.67

  14. Hemodynamic Codes • 50.95A Insertion of flow directed (Swan Ganz) catheter, and all monitoring thereof….. $ 112.81 • 50.95B Cardiac output studies………..$ 112.81 • Note: • 1. Claimable by whatever method • 2. One /day/patient

  15. Vascular Access • 50.91A Introduction of arterial catheter for pressure monitoring and/or blood gas monitoring percutaneous or by cutdown……$ 47.20 • 50.93A Percutaneous insertion of catheter into blood vessel (hemodialysis/perfusion)…………………………... $ 150.46 • 50.94D Introduction of central venous catheter, with or without ultrasound guidance ………………………………..$ 64.58 • NOTE: • This code has replaced 50.94A

  16. Family Conferences • 03.05JC Family Conference relating to acute care facility in-patient or registered emergency or out-patient, or auxiliary hospital, nursing home patient, AACC or UCC patient, per 15 minutes or major portion thereof……………$42.60 • NOTE: • Intended specifically for patients whose condition warrants periodic family conferences or for patients who are unable to properly communicate with their physician (e.g., situations where there is a language barrier, unconscious patient, etc.) • 03.05T Formal, scheduled, professional interview relating to the care and treatment of a palliative care patient with other physicians, family, and/or direct therapeutic supervision of allied health professionals or community agencies, on behalf of a specific patient, per 15 minutes or portion thereof . . . . . . . . . . . . . . . . . . . . . .. . . . .$ 46.13 • NOTE: • This service is to be claimed in the name of the patient by the physician most responsible for the patient.

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