Cardio is a huge medical department. It deals with any kind of heart and blood vessels disorders and treatments. 779 of the total cardiac hospitals in the USA are ranked under 50 to provide quality heart care to patients. One aspect of their successful operations is the billing system. Since billing is the same among all departments, each division has its own requirements under which they perform. So here we will be discussing cardiology medical billing.
Billing in the heart department is no different than in other healthcare areas. It contains the same steps as the normal process. But being associated with a specific department, you must know the intricacies of how they work distinctly.
That’s why today we have come up with the specific and detailed guide you need about cardiology billing along with some tips to succeed in the process.
Key Components Of Cardiology Medical Billing
The cardiac department runs with the help of predefined codes. These codes are different from other departments because of the dissimilarity in treatments. As we talk about the process of cardiology medical billing, here we have broken down the key components that form the pillar of this system. Let’s have a look at them:
CPT Codes
CPT stands for Current Procedural Terminology. These codes define a certain medical service given to heart patients. With the help of this coding language, insurance payers recognize the service received by their insurance holder and they then estimate the reimbursement they have to make.
Common Cardiology CPT Codes
Since each healthcare department has different codes, cardiology too is based on some unique codes that can’t be used in other healthcare areas.
Echocardiography:
- 93306: Real-time heart imaging to assess its structure and function
- 93307: Follow-up heart imaging for ongoing evaluation
Stress Testing:
- 93015: Exercise or medication-based heart stress test with continuous monitoring
- 93018: Recording of heart activity during the stress test, excluding interpretation
Cardiac Catheterization:
- 93458: X-ray imaging of heart’s arteries with injection of contrast dye
- 93451: Measurement of heart parameters, including oxygen saturation and cardiac output
Coronary Intervention:
- 92920: Opening a blocked coronary artery using a balloon
- 92928: Placement of a stent in a coronary artery to keep it open
Holter Monitoring:
- 93224: Continuous recording of heart’s electrical activity for up to 48 hours
Implantable Cardioverter-Defibrillator (ICD) Programming:
- 93279: Adjustment and testing of implanted defibrillator device
Remote Monitoring:
- 93294: Evaluation of implanted device and reprogramming through remote connection
Dive Deep into CPT Codes
ICD-10 codes
In cardiology medical billing, ICD-10 codes specify the diagnosis of heart diseases in the bill. Their accurate use is essential because any mistake can lead to claim denial. So ICD-10 are essential codes besides CPT that collectively describe the entire treatment in code language.
ICD For Cardiac Diagnosis
The following are the most common ICD codes that are used in routine cardiology procedures.
Coronary Artery Disease (CAD):
- I25.10: Atherosclerotic heart disease of the native coronary artery without angina pectoris
- I25.9: Chronic ischemic heart disease, unspecified
Heart Failure (HF):
- I50.9: Heart failure, unspecified
- I50.21: Acute systolic heart failure
Arrhythmias:
- I48.0: Paroxysmal atrial fibrillation
- I49.02: Other atrial premature depolarization
- I47.1: Supraventricular tachycardia
- I49.9: Unspecified cardiac arrhythmia
Hypertension:
- I10: Essential (primary) hypertension.
- I16.0: Hypertensive heart disease with heart failure
Myocardial Infarction (Heart Attack):
- I21.9: Acute myocardial infarction, unspecified
- I21.1: ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
Valvular Heart Diseases:
- I35.0: Nonrheumatic aortic valve stenosis
- I08.0: Rheumatic disorders of both mitral and aortic valves
Cardiomyopathy:
- I42.0: Dilated cardiomyopathy
- I42.9: Cardiomyopathy, unspecified
Modifiers
Modifiers are additional 2-digit codes that are used to better explain the heart service given. It clarifies the entire procedure to make the bill complete.
Examples Of Modifiers In Cardiology Billing:
Though there are many modifiers in the billing system, in cardiology here are a few examples that will help you understand their role in cardiology medical billing.
- Modifier 25: Indicates a separately identifiable evaluation and management service.
- Modifier 26: Designates the professional component of a service.
- Modifier 59: Signifies a distinct procedural service.
Best Practices In Cardiology Medical Billing
In cardiology medical billing, a typical process is executed. You have to collect the patient’s information, prepare a claim, and receive payment in terms of medical bills. But with the help of some specific guidelines, you will win in the process. In order to optimize the billing further and generate maximum revenue, here are the following tips to follow:
Accurate Documentation
When you list the treatments of cardio patients, you must make sure to add accurate details of the services. Add all the procedures done on the patents, what equipment was used, and what medications were suggested.
Up-to-date Coding Knowledge
Keep your coding information fresh and updated. There are a lot of changes that keep happening in the coding systems, resulting in the invention of new codes and the deletion of some existing ones. So ensure you keep an eye on valid CPT, ICD-10, and other codes to prevent coding errors.
Optimize Your Claim Submission
Many healthcare facilities are still running manually. They don’t realize how much this blunder costs them. Since manual claim submission has a high chance of errors, they face extensive claim denials and loss in revenue. So you should install an automated billing system in your hospital. This way your cardiology medical billing will be optimized, guaranteeing optimum revenue.
Strategic Use Of Modifiers
Modifiers are a crucial part of coding and billing. Make sure to use correct modifiers to further define the services.
Robust Denial Management
The proper denial management system is the key to eliminating claim rejections for a healthcare facility. Hire trained staff to handle your claim applications. Conduct routine claim tracking and keep a check on their status. If any of them are rejected, identify the cause and show a quick response. This system will increase the chances of quick approval and more and more revenue will be at your facility.
Some Errors To Watch For
Where you learned some best practices to maximize your profit, let us tell you some cardiology medical billing mistakes that you must avoid at all costs.
Incomplete Documentation
When creating reports for the patients, if you miss out on some supporting documents, it’s a huge turnover. It might cause problems at the claim submission stage.
Non-covered Services
Charging patients for the services they didn’t receive is an unethical practice that could damage your reputation. So bill them only for treatments that were given by the cardio doctor.
Late Claim Submissions
Don’t wait for hundreds of claim forms to be collected and submitted at once. Regularly submit the daily claims created during a specific period. Delaying the process may result in late reimbursement.
Communication
Problems arise at any stage of the billing process. So maintain open communication with the insurance payers and with the patients as well. This way you can convey the information and solve any directing problem early on. In short, collaboration makes your work easier.
The Art Of Cardiology Billing
As a beginner or experienced in cardiology medical billing, knowing the codes used, tips to optimize revenue, and errors to look out for can help you perform best. So make sure to follow the best practices, avoid the mistakes we mentioned, and generate quick reimbursement.
Remember that the billing process is the same everywhere. However, the healthcare facility’s success depends on how you conduct billing.