Cardiology is one those specialties that generally perform high-cost diagnostic and curative services, and getting reimbursed for such significant services means conclusive and convincing cardiology medical billing – adhering to cardiology codes, compliance standards and coding rules.
Cardiologist, who used to be comfortable with a fewer codes and compliance standards and coding rules, are now required to be abreast with period changes in cardiology codes, compliance standards and coding rules.
Amongst these evolving changes, cardiologists need to be aware of acceptability of the codes assigned, modifiers to be attached, medical necessity of performing and coding a procedure, component coding, and so on.
Acceptability of the codes assigned
Contrary to overlapping cardiology codes in the past, CMS has comes up with an exhaustive list of cardiology codes, meaning virtually an independent and appropriate code for every cardiology procedure. Therefore, Medicare, Medicaid, and private insurance companies can easily verify and ascertain whether or not you have aptly coded your procedures. Moreover, attaching a lower-paying code for a relatively costlier procedure does not make sense at all.
Apart from learning evolving coding numbers and their correct assignment, cardiologists should also familiar with changes that have been introduced in codes relevant to heart catheterization, revascularization, observation services and more. Many existing codes have undergone revisions, including iliac repair, angioplasty, non-coronary stent placement, wearable ECG recording, and non-invasive physiologic changes.
As of now, while billing for cardiology procedures:
- Cardiologists are required report most non-congenital procedures with a single code
- Catheterization coded for non-congenital studies cover injections, imaging supervision, interpretation and report.
- Imaging supervision, interpretation and report are included with the injection procedure and cannot be reported separately in the case of all cardiac catheterization procedures
- Cardiology-specific codes such as 93451, 93456, and 93503 are not allowed to be attached with modifier 51.
Medical necessity of performing and medical necessity of performing and coding a procedure
In certain cases, insurance payors may contest the medical necessity of certain procedures undertaken by cardiologists. Therefore, it crucial that cardiologists substantiate the necessity of those procedures that have sent coded. Otherwise, reimbursements for those procedures may be rejected for lack of sufficient proof.
Component Coding
Cardiologists’ services may often involve certain technical components, and there are specific coding ruling depending on the criticality of each of such technical components. A higher technical component should always be accompanied by a higher value code so as to maximize the eventual reimbursement. In cases where there are several technical components involved on the same, the lowest component should be singled out to prevent the mandatory 25 percent deduction being charged to any other higher paying technical components.
All of these evolving cardiology codes, standards, and rules may limit cardiologists’ ability to realize their reimbursement in full. Therefore, irrespective of you being interventional cardiologists, diagnostic cardiologists, electro-physiologists, nuclear cardiologists or cardiovascular/ cardiothoracic physicians, you may eventually need an effective revenue cycle management solution in place that is integrated with the right technology, processes and people to respond to Cardiology Billing and Coding dynamics.
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FAQs
Staying informed ensures accurate coding, which is essential for proper reimbursement and compliance with evolving standards. It helps avoid claim denials and financial losses.
It refers to using the most appropriate and specific codes for procedures, ensuring they align with current guidelines to facilitate claim approval.
Modifiers provide additional information about procedures performed, impacting reimbursement. Incorrect use can lead to claim denials or reduced payments.
Proper documentation justifies the need for procedures, supporting the codes used and ensuring insurers approve and reimburse claims.
Using outdated or incorrect codes can result in claim rejections, delayed payments, and potential audits, affecting the practice’s revenue cycle.
