Essential Tips for Handling Cardiology Coding and Billing

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Essential Tips for Handling Cardiology Coding and
Billing

• Medical Billers and Coders

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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 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. 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.
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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.
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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...
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Tip 3 Dont Overdo Symptom Coding Dont let the
emphasis on related diagnoses lead you to report
symptoms when you shouldnt. As per the 2019
ICD-10-CM Official Guidelines for Coding and
Reporting (Section I.B) If youve got a
confirmed diagnosis, report that instead of a
signs/symptoms code. Dont assign additional
codes for signs/symptoms typically associated
with a disease (unless theres an instruction
specific to that code that says otherwise). You
may report signs/symptoms not routinely
associated with the disease process.
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Tip 4 Understand the Role of Comorbidities For
risk adjustment, a simplified explanation is that
a patients 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
patients COPD, anemia, or arthritis into the
patients 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.
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• 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 patients
  conditions accurately. ICD-10 includes quite a
  few combination codes for various cardiology
  conditions. Make sure theyre being used when
  appropriate. Its also important to follow a
  codes instructions to use additional code,
  code also, or code first to make sure youre
  giving a complete picture.
• For example, compare whats 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).

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Tip 7 Focus on Diagnosis Instead of Symptom
Coding Its vital to avoid reporting symptoms
when they dont 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 shouldnt use
additional codes for the symptoms generally
associated with a disease. Symptoms that arent
usually associated with a disease may be reported
according to ICD-10 official guidelines.
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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.
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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.
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