Cardiology Coding Alert

Whether it’s compliance, contractual obligation, revenue optimization, resources to pay staff better or give more bonuses, morale, or more resources to expand care, there are many reasons to care about better documentation and accurate coding. Sometimes, the biggest motivation is simply better pay and more reimbursement. “Remember, pay shouldn’t be what drives the work, but lack of pay can prevent great work,” Church said.

Consider Teaching These Concepts First…

We think of doctors as smart and with good reason. They are. But coding is not easy, and there is plenty of nuance. Doctors need to start with easier coding concepts relevant to their everyday workload. Give them the opportunities to have successes they can then build on.

Evaluation and management (E/M): A good place to start is with the office/outpatient E/M codes. Start with a discussion of what constitutes a medically appropriate history/exam, then break down the medical decision making (MDM) chart into small pieces, one column at a time. E/M isn’t straightforward, but it does affect every encounter. So, begin by giving your providers bite-sized concepts they can apply immediately and using techniques such as mnemonics, whiteboards, notes, etc.

Diagnosis codes: The ways doctors learn about diagnoses in medical school don’t always translate to ICD-10-CM. A lot of what’s in the code book simply doesn’t match up with the doctor’s language. “Start with the most common codes and conditions,” said Church.

Common procedures: Just as you would start diagnosis coding education with commonly used codes, begin procedure code education with your provider’s bread-and-butter procedures and build their knowledge base from there.

… And Teaching These Concepts Later

Modifiers: Modifiers can get tricky, so it’s best not to introduce them right out of the gate. However, it’s good to work on these as you go along. It opens your providers’ eyes to show them how to bill atypical situations or more than one service at once. Most pertinent is modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to justify a same-day E/M service as a procedure and modifier 59 (Distinct procedural service) to report multiple procedures that otherwise can’t be reported on the same day.

Risk adjustment: “Risk adjustment is like an advanced primer on diagnosis coding,” explained Church, so start on this around the end of the first year. Think of it like this, he continued. “You don’t teach to the adjustment factor. You need to teach to the accurate diagnosis coding. The rest works itself out.”

New relevant code releases: As new codes come out, be sure to keep everyone updated on the changes that will have the greatest impact on them, such as the recent split/shared visit update or changes to how time is calculated for E/M visits.

Take In These Onboarding Recommendations

When making coding education part of your onboarding process, ease your provider into it in a logical way. Mix it up, incorporate active recall and easy-incentive quizzes, and show real examples. Use the following timeline as a template:

• First meeting: Revenue cycle process and the basics of CPT^® and ICD-10-CM codes
• Second meeting: Documentation requirements in the note
• Third meeting: How to level service and time-based billing
• Fourth meeting: Review notes and show how to level services
• Fifth meeting: Review of redacted notes that residents have billed and any areas of opportunity

Remember, you are building relationships and trust. Emphasize how difficult and confusing coding is. “Think of a grocery store,” explained Church. “There is an agreement between the grocer and patron. It’s the same with coding. You can’t leave items in the cart and walk out. You also can’t scan things twice,” he continued.