Cardiology Coding Alert

Here’s what you need to have to ethically report the higher-valued code

The threat: If your cardiologist’s documentation doesn’t clearly indicate what the physician did, you could be one of the cardiology practices losing out on reimbursement for peripheral procedures performed with heart catheterization, says Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc in Powder Springs, Ga.

Here’s how to point out mistakes to your cardiologists and enable you to submit the claim the procedure deserves.

Go In-Depth With the Problem

Poor documentation can mean missing out on ethical income. For example, Medicare pays much more for a selective renal angiogram (with catheterization of the renal arteries) than for a nonselective renal angiogram (with the catheter positioned in the aorta).-But many cardiologists don’t note whether they catheterized the renal arteries, so you end up reporting a nonselective angiogram, Miller says.

Similar problems crop up with lower-extremity angiograms: Did the physician catheterize the contralateral leg? Did the doctor image the legs via a contrast injection in the aorta?

Note: Some cardiologists also perform carotid angiograms along with heart catheterization. Physicians will rarely document whether they imaged the carotids in the aortic arch, in the common carotid or in the internal carotid. Bottom line: You need all of this information to be able to select the correct code, Miller says.

Look for the Likely Culprits

If you’re like most facilities, you use an automated record-keeping system for your catheterization labs. The vendors typically design their record-keeping systems for heart procedures, not peripheral procedures, Miller says. So these systems don’t make it easy for doctors to document peripheral procedures completely.

Sometimes, the doctor actually has to hand-write an addendum to supplement the information in the automated record to explain where he catheterized, Miller says.

Plus: The physician doesn’t always document the indications-or medical necessity for peripheral procedures, Miller says.

"I believe education is the biggest problem," says Robin Yazell, CPC, billing manager at Cardiology PC in Syracuse, N.Y. "The doctors don’t think about reimbursement, so they don’t think about having to document in detail."

Example: The physician may go into a lot of detail about the patient’s heart problems but not provide much information about why the patient required a renal, lower- extremity or carotid angiogram.

Implement This Solution

Best advice: Educate your cardiologists. "Physician associations can help in this area," Yazell says.

Miller suggests showing physicians the possible coding-scenarios and the extra reimbursement they can get for a selective, instead of nonselective, catheterization. "That helps them understand why the information is important," she says. Then teach them what to document to help you code accurately -- such as, which vessels-they catheterized and where the catheter was located when they injected the contrast.

Another tactic: When a new physician comes on board, have a coder spend the day in the cath lab with the physician. That way, the coder can observe what he actually does, and they can go over the documentation together afterward. If the physician goes into the renal artery, the coder can help him learn to document that properly -- and the coder can also learn more about the anatomy.

Unfortunately, it may be difficult to change your facility’s automated record-keeping systems, Miller says. But it wouldn’t hurt to ask vendors to upgrade their record-keeping software to allow full documentation of peripheral procedures.