Health Information Management

Tip of the Week: Consider dedicating coding staff to complex procedures

APCs Insider, May 25, 2007

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Yvonne Hoiland, CCS-P, CPC, CPC-H, RCC, PMCCI, senior coding consultant at Coding Continuum, Inc., in Tucson, AZ, recommends that hospitals add a dedicated interventional radiology (IR)/cardiology coder to their staff, or train existing coders to specialize in these types of claims.

Interventional radiology coding is "its own beast," and it's noteworthy that coders can obtain a specific credential (radiology coding certification) in this specialty, says Melissa Thurmond, CCS, a coder at Mary Washington Hospital in Fredricksburg, PA. Coders must have a strong knowledge of complex anatomy and vascular families in order to understand and decipher a physician's operative reports. A coder must also apply specific coding rules to IR. The following are two examples:

  • In a typical operative report, the physician documents each "stop" he or she makes with the catheter. A coder must know that he or she can only report the highest order in each vascular family (e.g., if a physician advances his or her catheter to a third-order vessel, the coder cannot report a first- and second-order catheterization in that vascular family). But not everyone grasps this concept. "Coders sometimes try to pick up every stop in a vascular family," notes Thurmond.
  • Another tricky guideline is coding an angioplasty in conjunction with stent placement. Coders often try to code both procedures, but can only code the stent placement (not the angioplasty) if the physician performs both procedures in the same vessel, Thurmond says. Encoders aren't always a help, as they don't tell you which code to report: They simply offer a code range from which to choose, she says.

Perhaps the biggest challenge in coding IR is the fact that it's component coding. Unlike a laparoscopic cholecystectomy procedure, for example, which a coder can report using a single CPT code, an IR claim typically includes multiple surgical and radiology codes.

(The above tip appeared in the May 2007 Briefings on APCs).

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