Ask Dr. Z

Please clarify when the interventionalist cardiologist can bill for the pre-procedure E&M, Consult, H&P, or Critical Care service when he consults a patient in the hospital and does a procedure (i.e., cath/stent/PCI) in the same day. Can you provide examples of what would be considered significant and separately billable to allow billing for both the E&M service and the procedure? Our providers insist since they have never seen the patient they need to evaluate and make a decision whether to perform the procedure (even when this is a STAT Cath, Code STEMI or a transfer from another hospital with a direct admit order to treat and transfer back).