Cardiology medical billing ranges from low-value diagnostic tests such as EKGs and stress tests, to high-value invasive procedures such as cardiac catheterization and placement of stents. All of them have specific coding and documentation requirements and different payer expectations. When all services are billed the same, problems will be afoot.

Procedure Volume and Coding Accuracy in Cardiology Medical Billing

Cardiologists treat lots of patients, and perform lots of procedures which means billing error don't occur in a vacuum. They occur hundreds of times throughout the month before patterns are recognized. Getting the code for a single procedure wrong in the Cardiology Medical Billing process means a great deal of revenue lost each month, compounded by the number of patients seen during a week of work.

Interventional cardiology is more complex. Procedures done on coronary arteries, peripheral vessels and the structures of the heart all have different CPT codes, add-on codes and documentation requirements for contrast. Documentation changes can result in denials of a valuable claim for a time-intensive service.

Global Periods and Post-Procedure Billing in Cardiology Medical Billing

In some cases, cardiology procedures have an associated global period where the fee for the procedure includes follow up visits. The medical billers in a cardiology practice must keep close watch on global period dates, so that they don't bill post-operative visits independently. These are denied and practices are forced to rework a claim that shouldn't have been sent in in the first place.

But not all visits during the global period are bundled. Any new and unrelated visit during a global period can be billed, using the appropriate modifier. Failing to be aware of this distinction can cost your practice money on visits it could be billing.

Diagnostic Cardiology Coding in Cardiology Medical Billing

Cardiology diagnostic tests, such as echocardiograms, Holter monitoring and nuclear stress tests all have technical and professional component considerations. When an outside facility performs the test and it is interpreted by the cardiologist, then the professional component is billed. With practice-owned equipment, a global is used. This is clearly one of the most common, pure and preventable errors in cardiology medical billing.

Podiatry Medical Billing: Navigating Coverage Rules That Catch Practices Off Guard

There is one area of Podiatry Medical Billing that can be especially challenging for more practices than any other: routine foot care. Podiatry routine services nail trimming, callus treatment are not covered if Medicare does not see the services as medically necessary due to a systemic condition. And that leaves podiatry practices with a billable medical service that can't be fully billed without risking compliance issues.

Medical Necessity Documentation in Podiatry Medical Billing

If the podiatry patient has diabetes or peripheral vascular disease or other systemic condition, routine foot care becomes medically necessary and can be billed. But the context of the patient's medical condition has to be apparent. They have to have the code for the systemic condition on the claim along with the code for the foot care service, and the notes have to explain how the condition makes it unsafe or unwise for the patient to do his or her own foot care.

If they don't have the documentation, podiatry medical billing claims for routine foot care will be rejected by Medicare's exclusion for routine care. Here, many podiatry clinics lose money because the billing staff isn't familiar with precisely what documentation they need, or verify it before the claim is submitted.

Surgical and Wound Care Coding in Podiatry Medical Billing

Podiatry medical billing also relates to surgical procedures such as bunionectomy, hammertoe repair, nail avulsions and wound care for diabetic foot ulcers. All types have their own set of codes and documentation requirements, and abide by the global periods. Wound care is a good example since correct measurements and stage or severity codes must be documented to support the clinical service billed.

Podiatry clinics with large diabetic patient lists also have to coordinate podiatry medical billing with any existing home health and wound care services being provided to the patient. Having overlapping bill dates and inconsistent claim submissions can result in denials and claims that must be supported with documentation and effort.

Getting the Details Right Across Both Specialties

The details of cardiology medical billing, just like podiatry medical billing, require specialist expertise to know how all the little things add up to improve revenue. Med Brigade provides that expertise for all accounts, ensuring the account remains clean and there is no disruption to cash flows while taking pressure off your staff.