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Is your Cardiology billing up-to date? A guide for Medical Billers and Medical Coders

Cardiology coding and billing are complex and comprehensive. Cardiology practices must work harder to submit claims successfully due to their complexity.

Numerous procedure codes and policies increase billing complexity. To give a brief overview, cardiac procedures that branch out into various categories:

  • Interventional Cardiology
  • Diagnostic Cardiology
  • Peripheral Vascular Studies and Imaging
  • Implantable and Non-Implantable Cardiac Devices
  • Nuclear Medicine (SPECT imaging)
  • Congenital and Pediatric Cardiology

They cover procedures from simple EKGs to complex heart transplants.

This article tackles common cardiology billing issues and offers tips to resolve them.

So, what causes problems while tackling Cardiology Practice Management? Let’s start with the obvious one:

Not Sharpened Cardiac Coding Expertise:

Cardiology coding experts require proficiency in three main areas.

HCPCS/CPTs codes

Diagnosis codes

Modifiers

We shall discuss them by numbers:

  • HCPCS/CPTs codes

Cardiac procedures demand extensive knowledge of each category of Cardiology. Create a code cheat sheet for interventional cardiology billing. The cheat sheet should detail code usage, including combinations for cardiac & non-cardiac procedures.

  • Un-specified Diagnosis Coding

Matching diagnosis codes to procedure codes accurately is challenging, particularly in cardiology billing.

Omitting codes like Z00.6 can impact reimbursement for LAAO procedures (WATCHMAN Devices). For LAAO (33340), report Z00.6 as a secondary dx on claims.

Use specific DX codes with comorbidities to support claims. Ensure accurate diagnosis pointers with highlighted primary and secondary diagnoses.

  • Missing key Modifiers:

Modifiers undoubtedly play a substantial role in proper reimbursement. There are a plethora of modifiers that help make claims, like 52/53, 26/TC, 59, and more. However, cardiac modifiers are critical, especially for coronary angiography, to ensure reimbursement. So, do not miss out on the revenue because of these informational modifiers.

The modifiers are 

  • LD (left anterior descending coronary artery),
  • LC (left circumflex coronary artery),
  • RC (Right coronary artery),
  • LM (Left main artery) and
  • RI (Rasmus intermedius artery)

Lack of Billing Specialists:

Outsourcing cardiology billing to experts is wise, given the complexity. Accurate coding is crucial, alongside billing, to ensure full reimbursement for services provided.

Not Using EHR more Often:

As a Healthcare Provider or Cardiologist, thoroughly update the documentation in EHRs. As for the coders, “if it is not documented, it is not done.” Detailed procedure documentation benefits coding, reduces audits, and increases clean reimbursements.

Not following LCD and NCD Policies religiously:

Verify medical necessity and coding using LCD/NCD documents before billing cardiology procedures. Medical necessity diagnosis codes, documentation requirements, coding combinations, & LCD/NCD should have them.

Also look into Payer Policies:

If LCD/NCD policies don't provide answers, consult Medicare and commercial payer policies.

Bundling Denials issues are pre-dominant:

Procedure code components are detailed in descriptions & often lengthy compared to other practices. Separately billing any key inherent component can lead to upcoding and bundling denials. So, what can be done here?

Look for Component codes inherent to the Services:

As a coder, the bill only appropriates unbundled components.

A neat trick to this is to look at what’s inside the description of the code, and you may find the answers. Check NCCI PTP edits to see if modifiers can be appropriately used per CMS and payer guidelines.

Not focusing enough on Prior-authorization:

Cardiac procedures are notorious for demanding prior authorization from the insurance company. Maintain a checklist of procedures requiring special attention. For each code, use payer resources or call them if unsure.

Skipping on Frequent Audits of Claims:

Perform random or scheduled audits to nip the issues in the bud. Proactive auditing improves charge posting and billing protocols over time.

Ill-managing of denials, A/R buckets:

Billing and coding skills are lacking with aged denials and unresolved claims. A capable staff is essential to reducing aging claims for pending reimbursement.

Calling it a day!

Stay updated on coding changes and billing trends regularly. The healthcare provider and billing team must collaborate closely to address any issues. With the right team, the revenue cycle can thrive despite challenges.

AltuMED is a Healthcare Revenue Cycle Management technology and solutions company. Our technologically advanced Practice Management Software, PracticeFit optimizes the Medical Billing workflows for Medical Practices, Labs and Third-Party Medical Billing Companies helping them collect maximum revenue. Find out more.

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