Cardiology coding and billing professionals need a specialized understanding of the subject due to constantly evolving treatment and technology. Moreover, this evolution is coupled with coding regulations and continuously evolving changes in cardiology billing.
Cardiology practices offer a variety of different services which include blood work, invasive procedures, and other interventions to patients in a variety of different settings. The charges for services are different depending on where the services were provided for example in same-day surgery centers, in a hospital setting, or the doctor's office.
The key component for efficient and profitable cardiology billing and coding process is- providers able to read and abstract physician operative notes.
Excellent working knowledge of current coding rules, Cardiology specific codes, and compliance standards are necessary for correct Cardiology billing and coding. Let us look at coming changes and discovering some of the best practices and tips for cardiology billing and coding.
Let look at CPT and ICD coding updates for Cardiology in 2020. Cardiology has 26 new CPT codes and 11 deleted codes and more than 450 code changes in the ICD-10-CM updates for 2020.
Codes for Leadless Pacemakers
Leadless pacemaker 33275 - Transcatheter removal of a permanent leadless pacemaker, right ventricular is revised and includes imaging guidance
Now the new code 33275 - Transcatheter removal of a permanent leadless pacemaker, right ventricular, including imaging guidance (Eg. fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed
Pericardiocenteisis (33016, 33017, 33018, and 33019) - There are 4 new codes for pericardiocenteisis are 33016, 33017, 33018, and 33019 while Code 33010 has been deleted. There are some codes such as 33017, 33018, and 33019 which are new and related to services in the pericardium.
Despite various changes in 2020, some minimal additions and revisions affect cardiology. Some of which are described below:
Addition of some codes for Cerebral Infarction (I63) includes :
• I63.81 – Other cerebral infarction due to occlusion or stenosis of the small artery (lacunar infarction is also included under this code)
• I63.89 – Other cerebral infarction.
Now, for hereditary cerebrovascular diseases, new codes include:
• I67.850 – Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL is also included with this diagnosis)
• I67.858 – Other types of hereditary cerebrovascular disease
After having insights about Cardiology coding updates in 2020, Let's look at Cardiology Billing and Coding 2020 best practices
Improper documents can put you at risk for audits, and decrease your billable expense reimbursements. Moreover, this will impact your revenue cycle. However, nowadays EHR systems are used to collect and store patient health information digitally. These records help to ensure the accuracy of documentation and track your patient's data.
Coding for some cardiac procedures such as cardiac catheterizations can be tricky and improper documentation can lead to the loss of codable components and potential codes. Commonly, changes are occurring in anticipated procedures, therefore thorough and complete documentation is critical.
ICD-10 includes a lot of combination codes for various cardiology conditions. Hence you should appropriately use these codes to capture the patient’s conditions accurately. Moreover, your coder needs to follow the code's instructions to use additional codes.
• I11.0 (Hypertensive heart disease with heart failure)
• I13.2 (Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease).
You must avoid reporting symptoms when they don't need to be included. For instance, if you are sure about the diagnosis of the patient, then you should be reported instead of using a symptoms code. Unless specified, you should not use additional code for the symptoms which are generally associated with a disease. Symptoms that aren't usually associated with a disease may be reported according to ICD-10 official guidelines.
Patient’s health status and spending are considered in relation to outcomes and costs for risk adjustment. For instance, if risk adjustment model is used then, a patient with diagnosis X and significant comorbid conditions may yield higher reimbursement (due to higher expected costs of care) as compared with a patient with the same diagnosis X but no comorbid conditions,
If a provider has documented diagnosis codes for any relevant comorbidities then it shows the complexity of the case. Moreover, these diagnosis codes for any relevant comorbidities helpful for payers to know about other conditions of patient as well as to estimate the patient's expected costs.
Many cardiology practices are now outsourcing their billing and coding due to multiple procedure rules, complex contractual adjustments, and codes that change regularly. It is crucial to reduce claims denial and ensure on-time reimbursement for these specialties. We are Medical Billers and Coders (MBC), having expertise in cardiology billing and coding and we provide error free Cardiology billing and coding services for on-time reimbursement.