Cardiology Coding Alert

Even so, coding consultants are paying special attention to the changes in the CHF codes. (See related box for the list of codes.)

The new codes could pose problems for cardiology coders, who will have to determine whether the CHF is systolic, diastolic or combined. Moreover, if the CHF is unspecified, coders will need to decide if the condition is acute, chronic or acute on chronic. "This will be no easy task," warns Jim Collins, CHCC, CPC, a coding consultant and compliance officer with Mid-Carolina Cardiology in Matthews, N.C.

In addition, having more codes at their disposal means that many cardiology practices will have to "update their encounter forms to reflect the code changes," says Sheldrian Wayne, CPC, a cardiology coding specialist with Atlanta-based Coding Strategies Inc.

These changes reflect an aggressive approach to tackling the CHF technicalities, Collins says. Without training for clinicians and deliberate provider training for coders, however, CHF coding could become difficult, leading to continued or consistent misuse of the codes and causing abnormal code utilization profiles that could hinder reimbursement.

In spite of these challenges, having more codes will help cardiology practices, Wayne observes. Code additions and revisions generally mean that there is more objective and definitive information available to describe a patient's condition, "which enables us to capture better statistical data for research and other purposes," Wayne says. And providing more specific diagnoses to payers helps establish medical necessity for many procedures, she adds.

Many cardiology practices fail to code to the highest level of specificity and use diagnosis codes ending in a 0, an 8 or a 9, Wayne explains. Chart review often reveals the specific information needed for a higher-level diagnosis code.

Wayne also urges cardiology practices to code the outcomes of diagnostic tests such as electrocardiograms and nuclear studies with the tests' definitive findings rather than coding the reason the cardiologist ordered the test, which may result in denial.