Prevent coding whirlwind with basics

The terminology used in an IR report makes all the difference when coding a procedure, says Collins. Proper coding tells the insurer that the physician performed X procedure in Y artery.

“Radiologists don’t always understand the importance of the documentation they provide,” says Collins. “If they don’t use the right words, they can cut reimbursement in half.”

One healthcare system lost $43,000 because of dictation errors. “Look at what a big difference proper word choice makes to your bottom line,” says Gates-Striby.

The buddy system

Just as Dorothy never traveled without Toto, don’t code in the land of IR without using the buddy system, says Collins. “If [you don’t], you are leaving a chunk of money on the table,” he says.

For example, pair pain procedure codes with the appropriate supervision and intervention codes, says Collins. There is not a one-to-one correlation with diagnostic and interventional procedures, just with the surgical code (3xxxx) and the accompanying imaging code (7xxxx). This holds true for each of the peripheral vascular interventions other than carotid and vertebral interventions.

“Interventional radiology coding differs from other types of coding because it involves component coding,” says Melody W. Mulaik, MSHS, CPC, CPC-H, RCC, of Coding Strategies, Inc., in Powder Springs, GA.

Poisoned poppies, flying monkeys, and other hazards

Count on coding pitfalls and numerous obstacles when traveling in the land of IR. Follow these tips to improve reimbursement:

It gives the codes more meaning, and the coders gain greater understanding of their effect on the revenue of the overall healthcare system.

“Make a transparency with IR codes on it,” she says. “When you receive a report, simply flip to the chart and trace the path of the procedure, entering codes as you go. The billing systems will do the work for you after that.”

“Everybody’s struggling with this,” Mulaik says. “Work together and make sure both sides bill appropriately and that it’s all supported by documentation.”

IR reports can get lengthy, and they should be, she says.

“You’re asking for a lot of money and you need to justify every single code that’s assigned,” says Mulaik.

“There should always be information to defend every single code assigned,” Mulaik says. “The procedure should never be implied. Good documentation contains all the information spelled out.”

Overcome IR denials

When Dorothy presented the witch’s broom to the Wizard of Oz, he didn’t celebrate her accomplishment. In fact, he tried to turn her away.

Chances are, insurers will do the same to you.

“Getting accurate codes accounts for only half the problem, believe it or not,” says Gates-Striby. “Then you have to get paid.”

For example, codes for Medicare catheter placements and interventions are paid based on multiple surgical rules, she says.

Insurers pay 100% reimbursement for the first procedure and 50% for the next four.

If more procedures require reimbursement, insurers essentially base payment on information contained in the report.

Further, each code has a relative value unit (RVU). Medicare reimburses approximately $36 per RVU.

Make sure that coders know and understand these simple facts, says Gates-Striby. “You could potentially cut reimbursement in half at the point of entry if you’ve swapped the reporting order of procedures,” she says. “You want the highest RVU on the first line.”

Enter the highest RVU code on line one of the claim, the second highest on line two, and so forth.

“You want to be paid 100% of the highest code, not 100% of a lower code,” Gates-Striby says.

Pull back the curtain on insurance claims by graphing the previous three months’ worth of reimbursements from commercial entities, says Gates-Striby.

Consider setting up an Excel file to track procedures, especially for commercial payers.

“Typical techniques do not catch decreased and inconsistent reimbursements,” says Gates-Striby.

Be on the lookout for duplicate denials on the same CPT codes, watch for access codes denied with percutaneous transluminal angioplasty (PTA) codes, and keep an eye on stents inappropriately bundled with PTA, she says.

“You may be very surprised at what you find,” she says. “We program ourselves to watch for denials, not underpayments. If you watch for this, you’ll save money.”

Nevertheless, Gates-Striby says, “there remains no clean, clear-cut, across-the-board method to avoid denials.”

Although Dorothy had the power to return to Kansas all along, she needed to learn a few things first. “When you have the same code for the same patient on the same day, denials are inevitable. What gets through without an issue this week will likely get denied next week.”

“Keep at it and don’t get discouraged,” Gates-Striby says. “But it does get easier the more you know.”

Editor’s note: This article contained excerpts from the HCPro publication Briefings on Coding Compliance Strategies. Information contained in this article originated from the HCPro audioconference “Interventional Radiology CPT Coding: Step-by-step strategies for arterial procedures,” presented in April. Visit www.hcmarketplace.com to purchase a recording.

Insider sources

Melody W. Mulaik, MSHS, CPC, CPC-H, RCC, of Coding Strategies, Inc., Powder Springs, GA; melody.mulaik@codingstrategies.com.

Jim Collins, CPC, CHCC, ACS-CA, CEO of the Cardiology Coalition, 4812 Hickory Lake Lane, Matthews, NC; jim@cardiologycoalition.com.

Linda Gates-Striby, CCS-P, ACS-CA, principal at Gates Physician Services, 6430 Westdrum Road, Indianapolis, IN 46241; lgatesgps@aol.com.

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