- August 22, 2024
- Posted by: Josh Knoll
- Category: Cardiology Billing
Treatments have advanced by leaps and bounds, in the last few decades, but heart diseases remain one of the major reasons for death among U.S. adults. With more than 20 million people in the country are facing coronary artery disease, Cardiology remains one of the busiest specialties. As a result, providers are getting crushed under Cardiology billing and coding responsibilities. The administrative aspect of healthcare is always changing, and it is creating a hurdle in achieving good revenue and providing high-quality patient care.
So what exactly is cardiology billing?
Cardiology billing is a specialty that involves appropriate documentation, various cardiology codes, and payment related to any and every kind of cardiovascular-related services. Owing to the intricacy of diagnostic and interventional cardiology procedures, awareness of the cardiology billing process and coding practices is extremely vital today in order to ensure a profitable revenue cycle management.
How the Cardiology Billing Process Works
In today’s competitive era, the process of cardiology billing begins from patient registration and insurance benefit verification. Prior authorization is often required for procedures such as echocardiograms, stress tests, or catheterizations etc. Upon completion of services, clinical documentation is processed and coded by certified coders before submitting claims to payers. Denial management and follow-ups become an important aspect here especially for the sake of revenue recovery and compliance.
CPT Code Range for Cardiovascular Procedures
Being in the business it is important for the cardiology coder to understand the importance of each code. As cardiovascular procedures are primarily represented by CPT codes ranging from 93000–93999? While some of these services include electrocardiograms (93000–93010), echocardiography(93303–93351), cardiac catheterizations(93451–93464), and vascular studies (93880–93998) etc there are lot more.
Common Coding Examples
Some of the common cardiology CPT codes are 93000 (routine ECG with interpretation), 93306 (complete transthoracic echocardiogram), and of course not to forget 93458 (cardiac catheterization with imaging).
As proper code selection prevents claim denials and ensures appropriate reimbursement. It is important for cardiologist practice to comprehending the function of CPT and ICD Codes in Cardiology Billing. CPT codes that describe the medical services that are performed and ICD for diagnosis or to note the current condition of the patient. Both codes combined provide the entire clinical picture to payers so that services are medically necessary and reimbursed accordingly. Inconsistencies between CPT and ICD codes typically lead to rejections or audits, so accuracy in cardiology billing is of the highest priority.
As a cardiologist, your focus is to provide care and support to your patients. But think of something, are you focused on your practice’s business side too? Three major signs indicate that you may not be paying enough attention to the revenue generation of your practice are:
- High claim denials
- Incorrect reimbursements
- High staff turnover
You spent years sharpening your medical skills and your ability to provide quality care, and poor Cardiology billing and coding services are robbing you of the rewards of this hard work. So, if you are witnessing warning signs, you need to ask yourself the right questions to resolve the issue.
Monitor Your Cardiology Billing Process and Ask These 3 Questions
- Is your documentation in the right place?
Documentation is one of the most tedious yet important parts of Cardiology billing for sure! Inadequate documentation can lead you to prior authorization denials, claim denials, and revenue loss. From patient information and medical necessity to all the services provided – everything should be documented accurately.
- Are the codes reliable?
Generating revenue from your Cardiology practice is all about providing the correct information. Due to the high complexity of the procedures, there are numerous coding requirements. You need to implement accurate diagnosis codes along with all existing comorbidities. Furthermore, the CPT codes and modifiers are necessary to ensure maximum revenue generation.
It is often observed by experts that there are major issues of upcoding and downcoding in Cardiology billing.
- Upcoding: Codes mentioned for the services signify more or extra services than those actually rendered
- Downcoding: Codes mentioned for the services are non-comprehensive and do not imply all the services provided
You need to make sure that every code used during billing is correct, precise, and according to the current guidelines.
- Do you know the latest guidelines and regulations?
Talking about the guidelines, do you know the current coding regulations and payor guidelines? There are frequent changes in healthcare coding regulations, and payor guidelines differ from one payor to another. It is quite difficult to stay updated with the comprehensive regulations while you are busy serving your patients.
However, the lack of knowledge of the same can lead to claim denials and revenue loss, which nobody wants in their practice.
So, what is the solution?
Stop Yourself from Facing Revenue Loss with Sunknowledge
Partnering with us will give you instant access to a superior pool of medical billers and coders which can help you reduce proven gaps in Cardiology billing. Experience our specialized skills to unleash the revenue generation potential of your practice.
Not only do we serve you with complete compliance, but also with our 15+ years of experience and expertise. Speak to our team to know more about how we deploy our resources to your Cardiology billing for the best outcome.