Essential Tips for Handling Cardiology Coding and Billing

1. Medical Billers and Coders Essential Tips for Handling Cardiology Coding and Billing

2. Cardiology billing and coding comes with multiple procedure rules, complex contractual adjustments, and codes that change regularly. CPT code assignment has the potential to be challenging, particularly when modifiers are used, and staying up to date with new codes, code revisions, and deleted codes take a significant time investment. Cardiology billing also offers a unique set of challenges. These challenges include human errors, lack of knowledge regarding current coding and documentation standards, working and charting in multiple care environments, and/or not coding to the highest degree of specificity. As in any specialty practice, clear and accurate, detailed documentation is the best way to ensure proper coding. One of the most important things you can do to minimize claims denials and boost practice revenue is to stay current on billing and coding changes.

3. Tip 1: Minimize Human Error We all make mistakes, and when dealing with up to 7 numbers and letters per code it is easy to enter them incorrectly, especially when dealing with multiple codes with complex patients and procedures. Whether you outsource your billing or manage internally, double-checking codes are imperative. As you become more accustomed to ICD-10 and CPT codes you will start to memorize frequently used ones and may quickly enter them into your system. This leaves room for careless errors and potential loss of specificity which can affect reimbursement.

4. Tip 2: Stay Updated on Cardiology Coding 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 (Office of the Inspector General), 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..”.

5. Tip 3: Don’t Overdo Symptom Coding Don’t let the emphasis on related diagnoses lead you to report symptoms when you shouldn’t. As per the 2019 ICD-10-CM Official Guidelines for Coding and Reporting (Section I.B): If you’ve got a confirmed diagnosis, report that instead of a signs/symptoms code. Don’t assign additional codes for signs/symptoms typically associated with a disease (unless there’s an instruction specific to that code that says otherwise). You may report signs/symptoms not routinely associated with the disease process.

6. Tip 4: Understand the Role of Comorbidities For risk adjustment, a simplified explanation is that a patient’s health status and spending are considered in relation to outcomes and costs. So a patient with diagnosis X and significant comorbid conditions may yield higher reimbursement (because of higher expected costs of care) than a patient with the same diagnosis X but no comorbid conditions, assuming a risk-adjustment model is used.

7. Tip 5: Be Aware of Combo Codes ICD-10-CM includes a lot of combination codes for cardiology conditions, so be sure you use them when appropriate to capture the patient’s conditions accurately. ICD-10 includes quite a few combination codes for various cardiology conditions. Make sure they’re being used when appropriate. It’s also important to follow a code’s instructions to “use additional code,” “code also,” or “code first” to make sure you’re giving a complete picture. • For example, compare what’s included in these two codes: • 0 (Hypertensive heart disease with heart failure) • 2 (Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end-stage renal disease).

8. Tip 6: Complete and Accurate Documentation is Key Problems with documentation can slow down your practice’s revenue cycle, put you at risk for audits, and decrease your billable expense reimbursements. Coding for cardiac procedures, such as cardiac catheterizations can be especially tricky, and documentation gaps may lead to the loss of codable components and potential codes. It’s very common for changes in anticipated procedures to occur, so thorough and complete documentation is critical. If documentation problems exist, it will slow down the revenue cycle, decrease billable expense reimbursements, as well as leave room for coding inconsistencies which may become a red flag for auditors.

9. Tip 7: Focus on Diagnosis Instead of Symptom Coding It’s vital to avoid reporting symptoms when they don’t need to be included. For example, if you have a confirmed diagnosis for a patient, that should be reported instead of using a symptoms code. Unless there are specific instructions noting otherwise, you shouldn’t use additional codes for the symptoms generally associated with a disease. Symptoms that aren’t usually associated with a disease may be reported according to ICD-10 official guidelines.

10. Tip 8: Always Code to the Highest Degree of Specificity A great example 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.

11. Tip 9: Audit Frequently 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.

12. Medical Billers and Coders (MBC) works with cardiology and other specialty medical practices around the country on billing, coding, contracting, and credentialing to help practices increase efficiencies and maximize revenue. Contact MBC today to learn more about how we can be the perfect partner for your cardiology practice.

13. Get in Touch Medical Billers and Coders Email : info@medicalbillersandcoders.com Toll Free no: 888-357-3226