Early Career Focus – Coding 101:
As you transition from training to full-time practice, understanding how to code for the services you perform becomes increasingly important. To put it simply: coding is complex. It takes time and practice to get up to speed on coding terminology and how to accurately code to ensure you are paid for your services. Here's a look at two common types of codes you will encounter in your career:
- CPT: Current Procedural Terminology is a code set that is used to report your medical procedures and services to health insurance companies. CPT is a listing of standardized descriptions and five-character, alphanumeric codes that you, medical coders and billers use to report health care services and procedures to payers for reimbursement. CPT provides a uniform language to accurately describe medical, surgical and diagnostic services. These codes are maintained by the American Medical Association (AMA). CPT codes are accurate – if the CPT code does not describe your service or procedure exactly you may need to use an unlisted code. The ACC has a Coding Task Force that is dedicated to providing information used to request new CPT codes for cardiology.
- ICD-9–CM: International Classification of Diseases, Ninth Revision, Clinical Modification is the system used in the U.S. to classify and assign codes to health conditions and related information. The use of standardized codes improves consistency among physicians in recording patient symptoms and diagnoses. On Oct. 1, 2015, the ICD-9 system will be replaced with ICD-10. ICD-10-CM will be used for diagnosis coding in all settings and ICD-10 Procedural Code Set (ICD-10-PCS) will be used for inpatient procedures (for hospitals only). Find out what you need to know about the transition here.
What is the connection between CPT and ICD-9-CM? When coding and billing your services every CPT code must be supported by a corresponding ICD-9 diagnosis code that supports medical necessity for the procedure and service that was performed. ICD-9-CM is connected to CPT coding because the former supports the medical necessity of the diagnostic procedure. Documentation of your services is the one essential point that will support both your selected CPT and ICD-9-CM code so that your services can be reimbursed accurately and will stand up to an audit.
Early Career Coding Guide: The ACC is here to provide you, as an early career professional, with the tools and resources you need to succeed in cardiovascular medicine. To help you along your coding journey, the Early Career Council and Section, a community dedicated to helping members transition from training to full-time practice, has developed a reference card with common codes
you will encounter in practice. For a hard copy of the card, email Amalea Hijar at firstname.lastname@example.org. For additional early career information and resources, visit CardioSource.org/EarlyCareer.
2015 CPT Coding Preview: You can breathe a sigh of relief! Changes to existing CPT codes for cardiology were kept to a minimum for 2015. Next year will see CPT codes for newer technology and procedures. Members are encouraged to review the many revisions for CPT codes and introductory language. Each year the American Medical Association (AMA) publishes an updated CPT book with all the new, deleted and/or revised codes. Often, the introductory language gets overlooked but this language contains updated coding guidelines that are of great importance to cardiovascular professionals. Key categories with updated language and new codes in 2015 include subcutaneous implantable defibrillators, transcatheter mitral valve repair (TMVR), implantable cardiac device evaluations, advanced care planning and extracorporeal membrane oxygenation. Get a detailed summary of next year's coding changes on CardioSource.org.
Navigate Coding Changes: Your ACC has several resources to help you efficiently and accurately report cardiovascular services and procedures next year. The 2015 CPT Reference Guide for Cardiovascular Coding, co-published by the ACC and the AMA, is designed to help cardiovascular professionals select the appropriate codes for diagnostic and therapeutic radiological and cardiovascular procedures. The CPT Guide also provides a complete overview of the heart structures, vessels and conduction system, including cardiovascular basics and common ailments. Stay ahead of coding changes. Order your copy today. You can also review a recent webinar on CPT changes for cardiology in 2015.
Now's the Time to Take Action on SGR: With the 113th Congress drawing to a close, we are faced with our last chance in this Congress to pass a bill to finally repeal the flawed formula for Medicare payments – the Sustainable Growth Rate (SGR). The current situation presents an unprecedented opportunity for repeal and momentum toward much-needed Medicare stability and reform will be stalled if this opportunity is missed. You and your colleagues have been integral in pushing the process this far. Join us again in demanding that Congress take this critical opportunity. Click here to send a letter to your lawmakers urging them to tell their leadership to take the “SGR Repeal and Medicare Provider Payment Modernization Act of 2014” (H.R. 4015/ S. 2000) to the floor for a vote before the end of the lame duck session.
Hospital Outpatient Forecast: Payments for hospital outpatient services are estimated to increase by 2.3 percent next year under the 2015 Medicare Hospital Outpatient Prospective Payment System final rule. In addition to the 2015 payment update, key provisions of the final rule include implementation of comprehensive Ambulatory Payment Classifications (APCs), and policies to package payment for add-on codes and some ancillary services, including electrocardiograms, cardiography and chest x-ray procedures when performed with a primary service. The final rule also eliminates the requirement for physician certification of inpatient admissions for cases other than long-stays and costly outlier stays. Read the 2015 Medicare Hospital Outpatient Prospective Payment System (HOPPS) Summary for more details. Join the ACC on Dec. 4 at 2:30 p.m. ET for a free webinar that will summarize the most important issues included in the 2015 Physician Fee Schedule and HOPPS final rules. Register now.
Regulation Revamp: Your ACC has joined with the AMA and a host of other medical specialty societies, laboratories and laboratory associations, urging the Food and Drug Administration (FDA) to reissue recently drafted proposed guidance, the “Framework for Regulatory Oversight and Laboratory Developed Tests,” through the notice and comment rulemaking process. While the FDA has claimed for some time that it has jurisdiction over laboratory developed tests (LDTs), it has not previously sought to exercise that jurisdiction. Instead, it has deferred to the Centers for Medicare and Medicaid Services (CMS) to regulate LDTs under the Clinical Laboratory Improvement Amendments. Proceeding through notice and comment rulemaking would allow the public the opportunity to provide feedback to the FDA on its proposal, as well as require the Agency to respond to the public’s feedback in writing. Additionally, regulations have additional force of law that subregulatory guidance does not. Notice and comment rulemaking does typically take longer than the guidance process, but it does ensure that the FDA proceeds in a deliberate and informed manner.
In the News: Dual antiplatelet therapy beyond one year after placement of a drug-eluting stent compared with aspirin therapy alone has been found to significantly reduce the risks of stent thrombosis and major adverse cardiovascular and cerebrovascular events despite being associated with an increased risk of bleeding and mortality, according to results of the DAPT trial presented this week at AHA 2014. In a statement released this week, the FDA said it is evaluating the preliminary data from the trial but believes the benefits of clopidogrel and prasugrel therapy continue to outweigh their potential risks when used for approved uses. The agency said “health care professionals should not change the way they prescribe these drugs at this time” and advised patients to “not stop taking these drugs because doing so may result in an increased risk of heart attacks, blood clots, strokes, and other major cardiovascular problems.”
Your ACC in Action - Advocacy Success Countdown: Earlier this year, your ACC collaborated with other medical societies to successfully request that CMS create national coverage for TMVR. The ACC was pleased that CMS responded positively to comments recommending deletion of its proposal to require joint intraoperative participation by both an interventional cardiologist and cardiac surgeon. The College also worked with other stakeholders to request an expansion of national Medicare coverage of cardiac rehabilitation. Those services are now covered for chronic heart failure patients. To report TMVR and other services, the ACC Coding Task Force successfully presented proposals, along with several societies, to create codes for TMVR, subcutaneous implantable cardioverter defibrillators, extracorporeal membrane oxygenation, and a new code to report transesophageal echocardiography guidance during transcatheter interventions like TMVR. See how else your ACC is advocating for you.
2015 HCPCS Annual Update: The scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set is posted on the Alpha-Numeric HCPCS web page. Final decisions for individual HCPCS code applications will be published soon on the HCPCS - General Information web page, so stay tuned.