Complexity in Cardiology: How Procedure Intricacy and Diagnosis Severity Lead to Coding Challenges

In cardiology, it's not enough for billing teams to solely be experts in coding —  these teams must also possess a deep, nuanced understanding of cardiology itself. 

Billing teams must understand cardiology anatomy and terminology on top of coding guidelines and regulations so that they can create accurate documentation. Following specific documentation requirements is essential for accurate coding — coding needs to communicate the patient’s condition, any procedure(s) performed, as well as the severity of the condition. There are often multiple codes for the same diagnosis, each indicating a varying level of severity. 

Because of the level of detail and complexity involved in coding for cardiology, denials are not uncommon. Different procedures or diagnostic tests may be denied, so billing teams must be on the lookout for these denials and have a strategy in place to appeal these when needed. A misstep here can result in lost revenue, delays in reimbursement, or payment responsibilities falling onto patients.

Real Life Example 

A great example of the nuance in coding here is if you look at the top 3 cardiovascular procedure codes. According to Definitive Healthcare, in 2023, the top 3 cardiovascular procedure codes were all related to electrocardiogram (ECG) procedures:

1. 93010 - electrocardiogram report
2. 93000 - electrocardiogram complete
3. 93005 - electrocardiogram tracing

In all 3 of these instances, an ECG was performed, but slight differences in the service require a change in code. For example, in situation #1, the ECG was performed without tracing, but provided with an interpretation and report. For #2, the ECG included both the interpretation, report, and tracing, and #3 only included tracing. These slight differences in the services rendered can mean the difference in a claim being denied, so that’s why documentation is so important.

Combatting Denials

Because of the nuance and complexity involved in coding, denials are inevitable. Coding errors, prior authorization and eligibility requirements, changing payer regulations, and more, can all lead to claims getting denied at a high rate.

As a result, it’s absolutely critical that cardiology billing teams have a strategy in place to help them identify denials, trends, and underpayments so that they can maximize their revenue. 

That’s where Adonis Intelligence comes in. Intelligence can play a key role in your denial mitigation strategy.

• Identify denial trends: Adonis leverages AI to constantly monitor your revenue cycle, identifying patterns and denial trends to mitigate future denials and offer recommendations for action.
• Reduce revenue leakage: The platform helps you identify and address underpayments that cause revenue loss.  
• Improve accounts receivable: Adonis streamlines the process of collecting payments. It helps you get paid faster, improving your cash flow.
• Lower cost to collect: The platform makes the payment collection process more efficient, reducing the time and money spent on chasing payments.

Learn more about how teams are leveraging Adonis Intelligence, here.