Coding Complex Cardiologic Diagnoses and Procedures

Posted by admin | March 10, 2017 , (0) comments

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One of the major difficulties of coding cardiologic procedures for medical billing is that many patients have multiple interacting diagnoses that must be coded. The current medical billing standard, ICD-10, provides more codes than the previous edition, ICD-9. Issues that occur commonly together, like atherosclerotic heart disease and angina, have their own unique codes. With more codes to choose from, medical care providers need to take specific notes in order to properly assign the medical billing code. In this article, we provide examples of patient details and how the details are incorporated into the medical billing process. These examples are not intended to be all-inclusive.

Timeframe

The time that lapses between patient myocardial infarctions determines whether the episodes were acute or not. ICD-10 specifies that a myocardial infarction is considered acute for 4 weeks after the initial episode. Providers have the option to select a separate code if a second myocardial infarction occurs within the 4 week “acute” period (as opposed to outside of this timeframe.)

Causal Relationship

Some medical codes, like hypertension, require the medical provider to note the cause of the issue. Renal or pulmonary relationships with hypertension have different codes that must be submitted for proper medical billing.

Stability

Atherosclerotic heart disease can occur with stable or unstable angina pectoris. Knowing if the condition is stable or not will help determine which code to use.

Location

Although cardiology is a organ-centered practice, there is sometimes a need to identify locations even more specific, like vessels. Medical providers should note the artery involved, if known. Arteries should also be noted as native or autologous, depending on whether the patient has had a valve replacement or not.

Acuity

Noting the condition as acute or chronic is also necessary to select the correct medical billing code.

Changes from ICD-9 to ICD-10 also make some notes unnecessary. Although it’s recommended to have more information than needed, there are some examples of conditions in which ICD-10 requires less information. For acute myocardial infarctions, it’s no longer necessary to note the episode of care (initial, subsequent or in sequence).

Medical providers can also note other conditions in ICD-10 that weren’t available in ICD-9. For example, cardiologists can note if the patient is underdosing, or taking less medication than prescribed. Properly coding this condition does require the provider to note if the patient is intentionally not complying and why the patient has chosen not to comply. Adding this condition does require the cardiologist to take more notes, but coding this condition gives better insight into the patient needs.

Although cardiology often requires diagnoses of multiple interrelated issues, it is possible to code complex patient issues correctly. Medical providers should take detailed notes to assist in the coding process. However, the notes should be updated as changes occur. Some notes may need to be added while others can be removed. Constant updates and monitoring ensure a clean medical billing process.

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