Medical billing is an important, sometimes complicated, time-consuming part of any medical office. Without proper billing, no one gets paid, and the work eventually stops. Having someone on your team who knows the ins and outs of billing and can handle it correctly without making mistakes is vital, especially if your medical practice is in a specialty field. In a specialty like cardiology, the coding and billing guidelines standards can vary significantly across payers. The area is constantly changing and evolving with new treatments and procedures. It is a lot to stay on top of. Let’s look at some of the most common mistakes in cardiology billing.
Not Pre-Checking Coverage Guidelines
Understanding the pre-authorization needs for your specialty is essential, but checking that coverage first is an often overlooked step. Forgetting the coverage guidelines before a procedure or test can result in denial and upset patients who get a bill they weren’t expecting. Some procedures and tests have specific requirements for referrals and pre-certifications, so make sure you’re covering all those variables beforehand.
Mistaken Modifiers
Modifiers are additions to the basic code that convey that the service was altered somehow. For example, if a significant test were added at the end of a separate procedure, that would be coded and reimbursed differently than if the test was an expected part of the procedure and was routinely done together. The modifier code would convey that.
Not Coding Co-Morbidities
In a cardiology practice, many patients will have multiple diagnoses, such as heart disease AND diabetes. Your coding should convey that there are multiple diagnoses so that your practice is fully reimbursed for the treatment and services provided. There are combination codes that your office can use, or the different co-morbidities can be coded separately, but forgetting to code them at all will cause your practice issues and possibly lost revenue.
Not Being Specific
In coding, not being specific enough can cause significant problems. When there are multiple codes for the same diagnosis, make sure you use the one that aligns most closely with the patient’s information. Opting for a general code instead of a better, more specific one is a common medical coding mistake, especially in specialty fields.
Coding For Symptoms
Since there are codes for both symptoms and diagnoses, ensure that you are coding for the diagnosis whenever possible. If there are additional symptoms outside of the diagnosis that you are billing for, you can add those using symptom codes. If you only bill for symptoms, you will miss out on valuable revenue.
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