Cardiology practices, like other specialty practices, offer a variety of different services, including blood work, invasive procedures, and other interventions to patients in a variety of different settings. The charges for services are dealt with differently depending on where the services were provided – in same day surgery centers, in a hospital setting, or in the doctor’s office. Accurate Cardiology billing and coding require an excellent working knowledge of current coding rules, cardiology specific codes, and compliance standards. Even small mistakes in cardiology billing and coding can result in denials that lower your practice revenue. Get ready to reduce errors and improve practice revenue in 2019 by learning more about the coming changes and discovering some of the best practices and tips for cardiology billing and coding.
New Cardiology Billing and Coding Changes for 2019
Although there are more than 450 code changes in the ICD-10-CM updates for 2019, there were minimal additions and revisions that affect cardiology. However, it is essential to familiarize yourself with the few changes relevant to the cardiology specialty.
Additions for Cerebral Infarction
New codes were added to the Cerebral infarction category (category I63), including:
- I63.81 – Other cerebral infarction due to occlusion or stenosis of small artery (lacunar infarction is also included under this code)
- I63.89 – Other cerebral infarction
When applicable, you may need to report an additional code (R29.7-) indicating the National Institutes of Health Stroke Scale for the patient.
Category I67 Has a New Subcategory
Other cerebrovascular disease (category I67) now has a new subcategory for hereditary cerebrovascular diseases. New codes in this subcategory include:
- I67.850 – Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL is also included with this diagnosis)
- I67.858 – Other types of hereditary cerebrovascular disease
With this new subcategory, there’s a new “code also” note instructing the reporting of associated diagnoses, such as vascular dementia, recurrent seizures, and cerebral infarction.
Other Code Revisions for Cardiology
- 197.64 – Postproc seroma of a circ system org fola a circ sys procedure
- 122.8 – Subsequent posterior transmural myocardial infarction (Q wave) (acute)
- T81.11 – Post procedural cardiogenic shock
- T46.4X – Angiotensin-converting-enzyme inhibitors
Best Practices and Tips for Cardiology Billing and 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. However, here are a few other tips cardiology practices can use to support proper payment in the future.
- Tip #1 – Accurate and Complete Documentation is Crucial– 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.
- Tip #2 – Don’t Forget Comorbidities– A patient’s health status isn’t just considered in related to outcomes, but also to costs. Patients that have a specific diagnosis along with comorbid conditions may result in higher reimbursements. Including diagnosis codes for any relevant comorbidities documented by the provider can show how complex the case is. For example, if a cardiologist is treating congestive heart failure in a patient, they may document that the patient’s arthritis, COPD, or anemia had to be factored into the treatment. Coding those comorbidities lets payers know about other conditions a patient has so payers are better able to estimate the patient’s expected costs.
- Tip #3 – 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 #4 – Be Aware of Combo Codes– 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.
Should You Outsource Cardiology Billing and Coding?
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. 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 billing and coding allows you to focus on patient care while enjoying improved profitability and cash flow for your practice.
M-Scribe 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 M-Scribe today to learn more about how we can be the perfect partner for your cardiology practice.