Is your Cardiology billing up-to date? A guide for Medical Billers and Medical Coders
It is not considered a news that Cardiology coding and billing in an operational cardiology practice comes off as extensive and widely comprehensive. Given the nature of complexity, the billing practices need to put extra effort in accomplishing the task of getting those claims across successfully to other side for collection.
Myriad of procedure codes and policies that comes with every code (set) also contribute in the hassle of already complex billing. Just to provide a quick idea Cardiac procedures fracture into various branches looks like this and more:
- Interventional Cardiology
- Diagnostic Cardiology
- Peripheral Vascular Studies and Imaging
- Implantable and Non-Implantable Cardiac Devices
- Nuclear Medicine (SPECT imaging)
- Congenital - Pediatric Cardiology
All these branches give birth to multiple procedures ranging from simple EKG or ECHO to more invasive procedures including heart transplant and valve replacements.
In this article we try to go through common issues married with cardiology billing and some key pointers to help you resolve those issues first hand.
So, what causes problems while tackling Cardiology Practice Management? Let’s start with the obvious one:
Not Sharpened Cardiac Coding Expertise:
Different from billing expertise, cardiology related coding experts should excel at least three main categories:
We shall discuss them by numbers:
- HCPCS/CPTs codes
Cardiac Procedures demand extensive knowledge on each category of Cardiology. Let’s say if we want to dip your toes in Interventional Cardiology – Cardiac Catheterization, we suggest cataloging each code and form some document that could be used as your cheat-sheet for the billing. This cheat-sheet should have enough information on when, where and how to use this code and importantly how to use them in combination with other cardiac and non-cardiac HCPCs and/or CPT codes.
- Un-specified Diagnosis Coding
Selecting the diagnosis code to the highest specifications with the Procedure code(s) reported can be tricky for any specialty but it certainly is for cardiology billing.
For instance, you can easily mess-up the chances of successful reimbursement of LAAO procedures (WATCHMEN Devices), if you miss its Primary and Secondary Diagnosis (Z00.6 - The Z00. 6 diagnosis code needs to be reported in the secondary position on the hospital and professional claim when billing for items/services related to a Qualified Clinical Trial) with the HCPCs code 33340.
Use highest specifications of DX Codes that describe the ailment the best with comorbidities (if any) that is supporting your case in the claim. Configure your diagnosis pointer settings, Primary and other secondary diagnosis to the principal diagnosis in the service line item should be made highlighted in each service line item.
- Missing key Modifiers:
Modifiers, undoubtedly play a substantial role in proper reimbursement. There is a plethora of modifiers that help make claims like 52/53, 26/TC, 59 and more. However, ‘Cardiac Modifiers’ are the ones that should also never be ignored especially with say, Coronary Angiography that NEED cardiac modifiers in order to get re-imbursed. So, do not miss out 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:
As we shared the complexity of cardiac procedures above it is a no-brainer that a cardiology practice might need to outsource it’s billing to a team of well-informed experts who excel at cardiac specialty. Not only billing though coding also needs to be on point so that no stone is left un-turned when it comes to getting proper reimbursement for services rendered.
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”. However, if every procedure and its component is perfectly recorded in PHR, it does two things: a) make the job of the coders easier; b) save a practice from external audit risks, if it comes to that. If coding is done properly via medical notes in place, clean and higher reimbursements of the procedures will come just come-off as easy perks.
Not following LCD and NCD Policies religiously:
To verify medical necessity and coding configurations – do not hesitate use Local or National Coverage Determinations documents against any cardiology procedures before getting into its billing. Medical necessity Diagnosis codes, documentation requirements, Coding combinations, LCD/NCD should have it.
Also look into Payer Policies:
When not getting answers, you want from NCD/LCD policies, also give Medicare and Commercial payers policies a go.
Bundling Denials issues are pre-dominant:
More than any other practice, the components of each procedure code are contained in (sometimes lengthy) descriptions. Any key component separately billed that is inherent to the service can cause upcoding and bundling denials. So, what can be done here?
Look for Component codes inherent to the Services:
Many a times, as a coder you would find yourself in a critical spot where you have to meticulously pick and leave out bundled components of a service and to decide what should and shouldn’t be billed separately.
A neat trick to this to look what’s inside the description of the code and you may find the answers. Also give NCCI PTP edits a look, making sure if there is leeway for a modifier to be fairly used in circumstances appropriated by CMS and payer guidelines.
Not focusing enough on Prior-authorization:
Cardiac Procedures are notorious for demanding prior authorization form the Insurances. Make sure, you are well aware of those procedures, forming a check-list and keep updating might help. Also, for every procedure code received, use look-ups provided on Payer portal or simply call them when unsure.
Skipping on Frequent Audits of Claims:
Perform random or scheduled audits to nip the issues in the bud. With time and experience proactive auditing can really help with charges posting and streamlining the billing protocols.
Ill-managing of denials, A/R buckets:
Sharp billing and coding skills can send clean claims to the payers but the situation can become soggy if you 120+ days A/R bucket is brimming with denials and unresolved claims. Claims pending reimbursement also need an equally capable staff that can lower down the percentage of aging claims.
Calling it a day!
Finally at the end of the day, keep yourself and the practice updated on new coding changes or billing trends. The Healthcare provider and the billing team should be in-sync and work in-tandem to resolve any issue that comes in the way. Even this process might look intimidating, with the right group of people the practice revenue cycle can only flourish!
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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