Cardiology Coding Got You Down? Use These 5 Tips For Success!

1. Medical Billers and Coders Cardiology Coding Got You Down? Use These 5 Tips For Success!

2. Your cardiology practice isn’t alone if you’re concerned about overcoming reimbursement hurdles in the coming year. Apart from nailing down CPT, ICD-10, and HCPCS code changes, you’ll also need a firm grasp on documentation requirements, quarterly CCI edits, regulatory updates, and revisions to modifiers, payer policies, the fee schedule, OIG watch list, and more.

3. Understand Coverage Neither federal nor private payers will pay for all available therapies and services. Instead, each payer has set up its own complex system of rules that determine what services and therapies will be covered when. It is important to note some payers may have additional requirements such as prior authorization or notifications for certain services and procedures particularly diagnostic imaging tests and other cardiovascular procedures. Be sure to check with the insurer for these types of requirements before rendering a service.

4. Proper Documentation Proper documentation is critical to justifying medical necessity and the selection of codes for billing. It tells the story of a patient visit by recording pertinent facts, findings, and observations. Payers will use this documentation to verify coding choices, site of service, medical necessity, appropriateness, and accurate reporting of furnished services. Each office note must tell a complete story and be able to stand alone. For example, auditors interested in services provided in July. 18, 2019 will only review that note; they will not look at notes from other visits unless referenced in the note from July. 18, 2019.

5. Highest Degree of Specificity To explain the importance of the highest degree of specificity would be diabetes. Diabetes including any of its chronic manifestations carries 3 times the risk weight than that of an unspecified diabetes code. Physicians should completely chart all relevant comorbid and chronic diseases so that risk-adjusted outcomes accurately reflect the quality of care delivered. Also, cardiologists need to remember some of the basics of coding and documentation. When appropriate, document the diagnosis rather than the symptom such as angina compared to chest pain

6. Stay Updated Always keep the most current ICD-10 CM and PCS, CPT, and HCPCS code books in the office. There are frequent changes and guidelines posted by CMS and various coding clinics. The AHA (American Heart Association) offers quarterly newsletters. Refer to the CMS website for updates and subscribe to any publications offered by CMS, OIG, and state and local agencies that regulate billing practices. Always look up codes in the alphabetical and tabular indexes. At times code may appear to be the correct one in the alphabetic index, but once looking further at the tabular index you may find notes and disqualifiers such as “code first” or “excludes”.

7. Frequent Audit Regular internal or external audits are encouraged to track common coding and documentation errors and to identify needs for further education of staff. An open line of communication should exist between physicians, nurses, CDI, coders, and billers. This will provide opportunities for questions regarding diagnosis, procedures, supplies used, etc to properly reflect the acuity and care of the patient.

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