Cardiology Coding Alert

Some coders, who want claims off their desk as soon as possible, tend to file first and deal with denials later, points out Debbie Rhodes, reimbursement director for Atlanta Cardiology Group. But she does not agree with this wait-and-see philosophy, particularly when it comes to issues of medical necessity.

We dont want to have to do clean-up after the fact, because every time we make a phone call to check on the status of a claim it costs us money, she explains. It actually saves money to take the time to get it right the first time.

Rhodes gives several keys to submitting a clean cardiology claim:

1. Keep the Goal in Sight.

In smaller cardiology practices, one coder may do it all, while in larger practices, charge entry clerks may input the data. If your situation is the latter, be careful the job description doesnt become so compartmentalized that the overall goal of the clean claim is forgotten.

If your charge clerks attitude is My job is just to enter data, then youre setting yourself up for denials, Rhodes warns.

She advises practice managers to make sure anyone working with reimbursement has a general knowledge of coding principles, Medicare regulations and carrier limitations.

Otherwise, they may take what the physician puts on the superbill or op report and automatically enter it, she says.

For example, in Georgia, nine diagnostic codes support medical necessity for a cardiac event recorder. But Medicare will not pay for a recorder to diagnose and treat suspected arrhythmia if it is a routine substitute for conventional methods of diagnosis, such as an EKG.

So if your entry clerks know which diagnosis codes can and cant be used for certain procedures, then they can prevent the wrong code from being entered, and thus decrease denials, Rhodes explains.

2. Educate, Educate, Educate.

Rhodes admits that in a busy cardiology practice, its difficult to find time to send staff off-site to seminars. But we have to remember that coding and reimbursement is becoming increasingly complex and is ever-changing, she says.

So even if your coding staff cannot attend the instructional classes, set up a mechanism by which they can benefit from the information you gleaned as a participant. This process also includes sharing printed material on reimbursement, regulations, and compliance, she adds.

For example, Rhodes circulates the states Medicare updates, managed care bulletins and other payer information to her staff and requires that they initial it after they have completed the reading.

Its very time-consuming to keep up with the information, yet its vital to do so. Make sure someone serves as gatekeeper, to screen the material, highlight the critical points, and make sure it is distributed andmost importantlyread, she says.

For example, after the Atlanta Cardiology charge entry clerks were [...]