Interventional Cardiology Billing

Interventional cardiology billing differs from its major counterpart, cardiology billing, by the procedures included in the billing system. Interventional cardiology is a much smaller, specific field that makes it much easier for the billing staff to keep track of all billable diagnostics and operations.

The interventional cardiology billing procedures, however simple the practice might be, is still prone to erroneous coding inputs and incomplete data. Every error on the supporting documents puts the practice at a disadvantage. It’s highly imperative to stress the need for accuracy in billing procedures, especially in specific practices like interventional cardiology.

Interventional cardiology requires an accurate description of the procedure performed by the physician to prevent potential losses in compensation or reimbursement. CPT descriptions are used by coders to quantify and categorize the procedure done by the physician. As procedures can be done both as an inpatient or an outpatient, procedures need to be categorized properly to specify the facility utilized to deliver the procedure.

Medical Provider Billing/Payment

CMS and most insurers typically reimburse and compensate physicians based on the fee payment schedule specified on the Current Procedural Terminology codes, which are updated and released by the American Medical Association (AMA). These CPT codes are utilized to report medical procedures and services as assisted by, performed by, or under the direction of physicians.

Relative Value Units

Relative value units (RVUs) are used to quantify a physician’s involvement in a procedure. These are billable units that describe the work done by the physician. Relative value units are only applicable to physicians and not medical facilities like clinics and hospitals. As interventional cardiology procedures are always performed in a medical facility, relative value units separate the billable work of the physician to the charges that the medical facility charged for the procedure.

Ambulatory Payment Classification

The Ambulatory Payment Classification is the way for the United States government to compensate medical facilities for outpatient procedures performed by physicians. Ambulatory Payment Classifications are crucial details to match a payment claim made by a physician with relative value units to justify an outpatient procedure.

Medicare Severity – Diagnosis Related Group

The Medicare Severity – Diagnosis Related Group (MS-DRGs) are utilized by payers to organize in-patient service into groups to have a uniform payment amount for the hospital stay, based partially on the patient’s diagnoses at the time of discharge. Medical facilities need to indicate the proper ICD-10 or ICD-9 codes on the claim form. As always, the facility is responsible for properly coding the claims for service.

Interventional cardiology billing procedures group the types of procedures performed by physicians based on the diagnosis. Grouping procedures enables coders to properly associate a procedure with another procedure that may be performed in correlation to each other.

The Procedural Groups

Diagnostic Cardiac Catheterization
Injection Diagnostic Cardiac Catheterization
Coronary Angioplasty without Stent (PTCA)
Coronary Atherectomy, Without Stent
Bare-metal coronary stent with angioplasty
Drug Eluting Coronary Stent with Angioplasty
Bare-metal coronary stent with Atherectomy
Drug Eluting Coronary Stent with Atherectomy
Bare Metal Stent – Bypass Graft Revascularization
Drug Eluting Stent – Bypass Graft Revascularization
Bare Metal Stent – Acute Myocardial Infarction Revascularization
Drug Eluting Stent – Acute Myocardial Infarction Revascularization
Bare Metal Stent – Chronic Total Occlusion Revascularization
Drug Eluting Stent – Chronic Total Occlusion Revascularization
Intravascular Ultrasound
Fractional Flow Reserve (FFR)
Percutaneous Balloon Valvuloplasty and Aortic Valve
Endovascular or Transthoracic Valves
Embolic Protection

Grouping interventional cardiology procedures also reduce the margin for error as it can identify which procedures cannot be included on the same claim. For medical billing, it is of utmost importance to be consistent to avoid raising red flags in filing for reimbursement on a claim.

MPMR offers premier interventional cardiology medical billing for practices nationwide. With twenty years of experience, rest assured MPMR provides expert coders, medical billers and practice management as well. Call for your free consultation today!