Achieve appropriate reimbursement for cardiovascular procedures
Episode 1
David Zielske, MD, an interventional radiologist who specializes in complex cardiovascular CPT coding for physicians and hospitals, highlights how awareness and open communication can solve complex coding problems.
Episode summary
The process needs to be fixed
As a physician, Dr. Z shares how he has seen problems in the process of coding since the beginning of his career. Many people in many different roles touch these codes in the paperwork and documentation as they make their way to the payer which leaves room for mistakes. And if the documentation goes out the door wrong, you don’t get paid. This applies to both private practice and hospitals.
In fact, Dr. Z highlights that even after identifying this problem years ago, when his team audits hospitals today, this is still a prominent issue happening in 70‑80% of hospitals. It’s not only that many different people who do not communicate often touch these codes, it’s also important to note that these codes are complex and constantly changing. Keeping up with this alone is a challenge.
4:15 “People at hospitals tend to be very siloed…and when everybody is doing their individual jobs and passing it onto the next person without a single point of accountability or a single process to make sure that it gets out the door correctly, the errors happen. Multi-billion dollar organizations change slowly and a lot of them don’t even know this is happening and once they’re aware of it, it’s a multi-year process to make some of these changes.”
Pandemic compounds existing problems
Due to the COVID-19 pandemic, elective procedures were shut down. As a specialist in complex cardiology, Dr. Z saw the cath lab volumes drop by 60‑70%. When these numbers go down, hospitals are losing both revenue and expertise, as they have to furlough talented physicians and surgeons, who will often leave to find a job elsewhere. And when your organization isn’t consistently coding these complex procedures, your teams become rusty. This only exacerbates the issue that already exists, and makes compliance and reimbursement more difficult as mistakes add up.
Education, accountability, and communication
COVID-19 has everyone’s focus but your team can take this time to sit down and make sure that documentation is improved and complete across the board. This is important clinically for physicians and patients, but it also impacts reimbursement and billing.
Dr. Z emphasizes that education around codes, accountability, and communication between physicians, technologists, and coders is key.
9:14 “Remote coding is pretty much the standard now. The coders hope to communicate with the physicians through some sort of email system… to get their attention but that doesn’t always work so well. When we were on site in the hospitals, you could walk down the hallway and talk to the doctor and ask them a question about something. Those days, at least for the foreseeable future are pretty much gone because everyone is working remote. And so opening up the lines of communication to really be effective is important.”