Cardiology is a medical specialty that is complex with ever-changing treatments and procedures. In the same manner, cardiology billing and coding is also a complex process due to the various procedural guidelines, payer policy changes, ICD 10 requirements, new government mandates and an exhaustive list of CPT codes. It is an undeniable fact that most cardiologists find it challenging to navigate through this process successfully. Cardiology billing and coding requires skilled personnel who stay current with the latest updates on billing guidelines, code-specific rules and compliance requirements. Even a minor mistake can lead to claim denials and a loss of revenue for the practice.
Here are some of the best practices to be applied in cardiology medical coding and billing services.
Inadequate or improper clinical documentation can lead to inconsistencies in coding. Cardiology being a specialty that experiences frequent changes to procedural rules, improving the accuracy of clinical documentation can help stay clear of compliance risks. So, make sure to use EHRs to maintain accurate and complete documentation which is crucial for successful medical billing and coding. As you are aware, manual record keeping is prone to errors and not efficient as electronic record keeping.
Be mindful of combination codes
ICD-10-CM includes combination codes for several cardiological conditions. A patient may present with two medical conditions. In such a case both the conditions have to be coded for. These combo codes can be quite misleading. Physicians should be aware of guidelines for combo codes when using them. This avoids separate and erroneous reporting of diagnoses included in combination codes. Hence, to ensure accurate payments to your practice make sure to use combination codes properly.
Cardiology coding and guidelines keep changing. It is important to stay current with the frequent updates on ICD-10 CM, CPT and HCPCS code sets to ensure compliant-rich coding. Keep coding manuals handy for quick reference. Additionally, you can also refer to CMS website or subscribe to their publications. Make sure to check the alphabetic index and the tabular index at the time of assigning codes. This is important because the alphabetic index and the tabular listing can be confusing. Sometimes codes may appear to be correct in the alphabet index, but the tabular list may indicate a disqualifier.
Avoid coding for symptoms, instead code for diagnosis
Do not assign codes for signs and symptoms that are associated with a condition for which a definitive diagnosis is not provided by the provider. Take for example code for angina which is a diagnosis instead of for chest pain which is a symptom of angina observed in a patient. However, it is recommended to report additional signs and symptoms that are not associated routinely with the diagnosis as it helps the payer get a picture of other possible medical conditions that the patient may have.
Conduct frequent audits
Conducting frequent internal and external audits helps to identify inconsistencies in your cardiology billing services. It also helps to spot the pattern of errors and perform a root cause analysis to stop repeated errors in its tracks. Most importantly, regular audits help maintain high compliance standards, prevent denials and lost reimbursements. It can also identify areas where staff education and training is needed, as well as make sure that proper cardiology coding standards are followed.
Consider comorbidity coding
Cardiology patients usually present with one or more co-occurring conditions referred to as comorbidity. For e.g., a person diagnosed with a medical condition X and the presence of one or more comorbid conditions will yield higher reimbursements as they may require extensive treatment, resulting in higher health care costs. Coding comorbidities is important as it helps the payer have a clear picture of the additional conditions the patient has and accordingly assess the costs.
Avoid human errors
The overwhelming number of ICD codes in cardiology billing can create room for human errors, leading to claim denials. Particularly, when dealing with 7 numbers and letters per code human errors are more likely to occur. Hence double checking of codes is imperative to prevent denials and avoid loss of revenue to the practice. However, once you familiarize yourself with the frequently used ICD and CPT codes it becomes a breeze. It also eliminates human errors and lack of specificity that can cause issues with reimbursements.
Strict adherence to the above discussed best practices of coding and documentation is crucial for maintaining a healthy revenue cycle in a cardiology practice. If getting the full reimbursements for your cardiology practice seems to be a challenging task Scribe4Me billing experts are here to help you with your billing process. We have a team of certified professionals who have the experience and knowledge in cardiology billing to ensure cleaner claims and faster reimbursements. Availing the services of cardiology billing experts allows you to focus on patient care, while enjoying profitability and cash flow to your practice. Well, if you are interested to know more about our cardiology billing services get in touch with us.
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