cardiology coding guidelines

Cardiology for decades has been an ever-growing discipline, with new treatments and therapies, diagnostic tools, and medical procedures introduced on a regular basis. Considering that it is also one of the more complex fields; failure to keep pace with the latest developments in the billing and coding process is commonplace. 

However, with the implication of the new ICD-10, accurate documentation is imperative to achieving a consistent audit and ensuring complete revenue reimbursement. Whether you handle billing and coding in-house or have outsourced the operation, the process can be affected by:

  • Human error 
  • Lack of knowledge on updated ICD 10 CM, ICD 10 PCS ,CPT codes  & HCPCS codes
  • Upcoding or under-coding medical proceedings
  • Lack of expertise in the use of code modifiers

Accurate and consistent coding is key to securing successful billing returns and reimbursement for all the patient care you have provided. The following cardiology coding guidelines can help you in achieving this goal successfully. 

Tip #1 – Update Cardiology Coding Guidelines Regularly

Booklets for coding systems like ICD-10 CM, CPT, HCPCS, and PCS should always be kept on hand in the clinic for quick and accurate reference. They should also be updated regularly as new editions are published with the revised code. The staff should be fully aware of any updates to the cardiology coding guidelines in 2022.

You should also subscribe to newsletters by AHA (American Heart Association), CMS, OIG (Office of Inspector General), or any other agencies that oversee medical billing and coding in your area. 

While coding, always checks alphabetic and tabular indices in the guidelines. Sometimes, a procedure or diagnosis code may appear applicable in the alphabetic index, however, the tabular index may indicate a disqualifier such as ‘code first…’ or ‘excludes…’ Avoid such oversight by ensuring a keen grasp over cardiology medical codes and reference to official guides. 

cardiology coding guidelines

Tip #2 – Avoid Symptom Coding, Code for Diagnoses Instead

Experts in cardiology coding and billing advise against coding for symptoms. Instead, they suggest reporting confirmed diagnoses only, as well as the procedures carried out and the ailment that has been treated. For example, code for angina (diagnosis) instead of using the code for chest pain (a symptom) in a cardiology patient. 

Do not report symptoms that are regularly associated with the diagnosed disorder, unless the specific code instructs otherwise. It is, however, recommended to report symptoms that are not associated with the diagnosed disorder. This helps the payer fully understand the patient’s range of other possible health conditions. 

Tip #3 – Audit Frequently

Once a company practices a regular timeline of audits, it can establish patterns and areas of errors. Regularly auditing helps to identify major shortcomings in billing and coding, and therefore you can assess your staff’s expertise. Further awareness of staff will minimize the errors. 

Conducting the auditing records regularly can open communication between medical staff such as auditors, coders, billers, nurses, and physicians. This will open the floor to discussion and questioning regarding the quality of patient care and augmenting it to a higher level. 

High accuracy of documentation and rectification of common shortfalls enhance the overall quality of claims. Chances of your claims being denied will lessen along with external audits. This will lead to faster reimbursement, increased revenue, and increased compliance. 

Tip #4 – Watch Out For Human Errors

Cardiology billing can be challenging for many coders, leading to minor and major errors in the process. Due to this, human error in coding is the number one cause of claims denial in billing. 

If the coder has a history of working in other specialties or has been coding in cardiology for a considerable time, it is easy to mix up codes if not deliberated before entering it in the system. Also, it is easy to jumble up 5-7 digit codes while entering manually. 

You could remedy these errors by introducing a system of double-checking all codes when they are entered by the staff. This would increase the accuracy of your records before they are audited. Next, you could download a medical billing software that would update the latest ICD-10 codes to your system on its own. Lastly, as previously mentioned, you should regularly audit your records to look out for any patterns of error and eliminate them. 

Tip #5 – Be Highly Specific and Use Combination Codes

Insurance companies are only able to reimburse you for the documentation of patient care that your healthcare institute provides. Inaccurate or incomplete documentation can lead to inconsistencies in audit records and cause a denial of claims. Thus, complete and accurate documentation is crucial for increasing returns in the revenue cycle. 

There must be no gaps in documentation. For example, if cardiac catheterization was carried out but not documented, the institute will not be reimbursed for it due to non-verification. Similarly, any changes in procedure or use of supplies must be accounted for, to receive a complete reimbursement.

Combination codes are also important in documenting the patient’s thorough diagnosis. A patient may present with more than one medical condition; both conditions should be coded for. For example, if a patient presents with heart failure and acute kidney failure, you can use codes for both conditions since they are both confirmed diagnoses. This is important since healthcare institutions are reimbursed according to their diagnosis procedures. The use of combo codes will ensure that you receive accurate returns. 

Tip #6 – Employ Highly Trained Staff

Cardiology billing and coding require expertise and skill. Practitioners must be able to comprehend the hidden nuances in codes, have a proficient grasp of code modifiers and disqualifiers, and be able to compound this knowledge with in-hospital situations. 

It is also important that cardiology billers and coders are highly experienced staff members and are up to date with client-specific coding guidelines. You must also ensure that all staff members are up to date with any revisions in cardiology coding guidelines according to ICD-10 CMS, ICD 10 PCS , CPT, and HCPCS. 

coding guidelines for cardiology

Tip #7 – Use EHR

Cardiology, being a complex and crucial field, often sees swift changes in procedure. This requires vigorous documentation to ensure there are no gaps in the narration of patient care and all that procedures and treatments are coded for.

Physical record keeping allows room for error and is not efficient compared to electronic health records. EHRs ensure timely clinical documentation on the go. Additionally, medical billing software systems store the most recently updated codes, so you need not worry about outdated coding in your healthcare institute.

How Can You Optimize Cardiology Billing And Coding?

Coding and billing are necessary to run a healthcare institution successfully. Accurate coding leads to faster reimbursement, consistent audits, and smooth revenue cycles. If you follow the cardiology coding guidelines above, your coding and billing accuracy will increase. 

Highly trained staff, periodic audits, and keen comprehension of diagnostic tools and complex technology are important for optimizing the billing and coding systems. For this purpose, outsourcing cardiology coding and billing and following coding guidelines for cardiology closely might be your safest and most promising option. Experts from billing companies are highly trained in cardiology and are the most reliable candidates to handle your data. 

See Also: 3 Best Practices For Patient-Friendly Medical Billing Statements

This will also ensure that you are provided coding and billing services and top-notch revenue cycle management strategies that minimize errors and streamline the reimbursement process.

You can click here to visit our website, Precision Hub, and learn more about coding guidelines for cardiology, hospital billing, effectively reviewing your revenue cycle and more.

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