Cardiology billing and coding come 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 takes 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.
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.
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..”.
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.
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.
In other words, including diagnosis codes for relevant comorbidities that the provider documents help show the complexity of the case. For instance, if the cardiologist is treating a patient with congestive heart failure, you may see the documentation that the doctor had to factor the patient’s COPD, anemia, or arthritis into the patient’s treatment.
Experts advise that coding the comorbidities lets the payer know the additional conditions the patient has so the payer can better estimate (and not underestimate) the expected costs for the patient.
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).
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.
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.
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.
Also, chart to the highest degree of specificity such as systolic or diastolic CHF compared to CHF unspecified. They are different diagnoses and the different codes may impact how care is reimbursed or graded. In other words, this impacts revenue and risk adjustment.
More complete and accurate documentation will leave less room for translation and coding errors such as mismatched diagnosis and procedure codes.
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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.
Maintaining current education, documenting properly, and utilizing good coding practices will result in a faster return in the revenue cycle, decrease external audits, and overall improved compliance. As in all areas of healthcare, multiple parties are involved in painting an accurate picture of the patient’s overall care and level of acuity. Frequent audits will ensure correct reimbursement and documentation.
Any mistakes can prove costly, which is why many cardiology practices are now outsourcing their billing and coding to professionals who have knowledge and experience in this specialty. Choosing to Outsource Cardiology Billing and Coding allows you to focus on patient care while enjoying improved profitability and cash flow for your practice.
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.
FAQs:
1. What are the common challenges in cardiology billing and coding?
Common challenges include complex contractual adjustments, frequent code changes, human errors, and a lack of knowledge about current coding standards, which can lead to inaccuracies and reduced reimbursements.
2. Why is accurate documentation crucial in cardiology coding?
Accurate documentation is key to ensuring proper reimbursement and avoiding audits. Gaps or inaccuracies can slow down the revenue cycle and lead to loss of billable components.
3. How should comorbidities be handled in coding for cardiology patients?
Comorbidities should be included in the coding to reflect the complexity of the patient’s condition, which can lead to higher reimbursement based on expected care costs.
4. What does coding to the highest degree of specificity mean?
Coding to the highest degree of specificity involves using the most detailed codes available, such as specifying the type of heart failure (systolic vs. diastolic) to ensure accurate risk adjustment and reimbursement.
5. How often should audits be conducted in cardiology practices?
Regular audits—both internal and external—should be conducted to identify coding errors, improve documentation practices, and ensure compliance, which ultimately supports accurate reimbursement.
