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Cardiology Medical Billing

bobkruse | Jun 28, 2011 |

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Cardiology medical billing involves billing for the various services and procedures provided by physicians in this field. This is to be done in a timely manner to ensure that the reimbursement due for services rendered is received promptly. Any healthcare organization will have to keep pace with the periodic changes in cardiology codes, compliance standards and coding rules. Cardiology coding and billing is a highly complex job that demands exhaustive knowledge and expertise.

Interventional cardiologists, diagnostic cardiologists, electrophysiologists, nuclear cardiologists and cardiovascular/cardiothoracic surgeons require cardiology medical billing done on a regular basis. In order to get rightful reimbursement from Medicare and other government as well as private payers, a practice must have a working revenue cycle management solution in place that ideally integrates the right technology, processes and people. Cardiology billing demands comprehensive knowledge regarding the cardiology codes insurance payers recognize and reimburse. When billing for cardiology procedures, one has to be cautious about the codes assigned, the modifiers attached, medical necessity checking, component coding and many other associated factors.

Medical Billing to be in Keeping with the 2011 Cardiology Code Changes

CPT 2011 has 20 new and 23 deleted codes for the cardiovascular system, which physicians have to be familiar with. Changes have been introduced in codes relevant to heart catheterization, revascularization, observation services and more. Many existing codes have undergone revisions, including iliac repair, angioplasty, non-coronary stent placement, wearable ECG recording, and non-invasive physiologic studies.

Here are some points to note:

•    93224-93227 – these codes now signify external electrocardiographic recording up to 48 hours by continuous rhythm recording and storage
•    93228-93229 -- External mobile cardiovascular telemetry
•    93228 cannot be used with Holter monitoring codes 93224 or 93227. 93229 cannot be reported with 93224 or 93226.

When billing for cardiology procedures, keep in mind the following relevant points:

•    Most non-congenital procedures have to be reported with a single code
•    Injection procedures including injection, specific catheter placement, and radiologic supervision and imaging have to be reported.
•    The codes for congenital cardiac catheterizations remain the same.
•    Catheterization coded for non-congenital studies cover injections, imaging supervision, interpretation and report.
•    Imaging supervision, interpretation and report are included with the injection procedure and cannot be reported separately in the case of all cardiac catheterization procedures
•    Modifier 51 should not be attached to 93451, 93456, and 93503.

Specialized Service Providers Can Assist You

Physicians might find it difficult to keep abreast with these confusing changes introduced from time to time. When patient care is the top priority, you might not get the time to study and understand all these complex details. It is advisable to find a specialized medical billing firm to take care of this very important, but highly demanding job. A partner firm will have professionals dedicated to doing billing and coding. Naturally, they will have the expertise to carry out these jobs accurately and on time. The staff in reputable firms is given periodic training to keep them up to date with ongoing changes regarding CPT directives. They will know which procedures can be billed and manage your medical claims efficiently.

Cardiology billing and reimbursement process involves many important aspects that demand careful attention.

•    You have to create patient claims, submit them promptly and do the necessary follow-up
•    Deal with all the patient calls connected with billing
•    Familiarity with all coding strategies/conventions
•    All insurance payments have to be verified against each payer contract so that you can identify any underpayment
•    Trace lost claims and follow up on denied claims
•    Compliance with government rules and regulations

A good medical billing service provider will take care of all these details and ensure that you get paid for services provided. You stand no risk of issues such as overcoding, undercoding and incorrect coding. With trained and experienced medical billers and coders, excellent infrastructure and constant updates regarding the latest coding and billing regulations, your partner medical billing company will allow you ample time that you can put to more productive use.