Cardiology Case Surgery — Surgical Coding Series: WHP Coding Conundrums
nnAs part of the new coding format for our newsletter, Welter Healthcare Partners is excited to offer you a new surgery coding series in which we want to help you! The 2nd week of every month we will highlight a complicated surgical case. This week we are highlighting a general surgery case. We want to hear from you! If you have a complicated surgery case and need help with coding, please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected. Click Here To Submit Redacted Surgery Case StudynnProcedure: Left heart catheterization with selective coronary angiography and ventriculogram.nnIndications: 73-year-old woman with a history of hypertension who presents with acute chest pain and who was found to have an abnormal stress test.nnFindings: n
- n
- Hemodynamics: Left ventricular pressure as well as aortic root pressure were normal with mildly elevated left ventricular end-diagnostic filling pressure. No specific gradient was seen across the aortic valve suggesting aortic stenosis.
- Ventriculogram: In the right anterior oblique view ventriculogram was performed and demonstrated normal ventricular systolic function of 60% with no segmental wall motion abnormalities. No significant mitral regurgitation was appreciated.
- Coronary anatomy: The left main gave rise to the left anterior descending artery and left circumflex branch. The left main was free of any significant disease.
- The left anterior descending artery was a good size vessel that wrapped around the apex and gave off several septal perforators, as well as three diagonal branches. Diagonal 2 was a larger vessel and the LAD as well as the diagonal branches had a small contour and no high grade obtrusive lesions were appreciated.
- The left circumflex is a large nondominant vessel which terminates within the AV groove and gives off a left posterolateral branch. The left circumflex gave off two obtuse marginal branch the larger vessel. The contour of this vessel and its branches were smooth and no high grade obstructive lesions were appreciated.
- The right coronary artery was a large and dominant vessel which gave off an acute marginal branch and terminated as a right posterolateral and right posterolateral branch. The contour of this vessel was smooth and no high grade obstructive lesions were appreciated.
n
n
n
n
n
n
n
Correct CPT and ICD-10 Codes:
n93458 -26 Modifier = Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performednnR94.39 – Abnormal result of other cardiovascular function studynnR07.9 – Chest pain, unspecifiednnI10 – Essential (primary) hypertensionn
nnCheck out this article about a half-dozen changes to the adjudication of Medicare claims-denial appeals that are designed to ease a backlog of cases.nnThe new rules for Medicare claim-denial appeals feature several changes crafted to ease administrative burdens and speed reductions in a backlog nearing 1 million cases. The new rules went into effect March 20. “This final rule streamlines administrative appeal processes, increases consistency in decision making across appeal levels, and improves efficiency for both appellants and adjudicators,” a Department of Health and Human Services fact sheet on the new rules says.nnThursday afternoon, three officials at the Office of Medicare Hearings and Appeals (OMHA) led a presentation to walk healthcare providers through more than a dozen significant changes in the new rules. OMHA reports directly to Health & Human Services Secretary Tom Price, MD.nnDisputed Medicare claims of more than $160 can be appealed to Administrative Law Judges (ALJs) and attorney adjudicators for reviews that can include a hearing. The last stop before federal court is the Medicare Appeals Council.nnThursday’s Medicare Learning Network (MLN) presentation featured a half-dozen changes to the claims-denials appeals process at the ALJ-level that are designed to either quicken or streamline adjudication:n
Medicare Advantage: You have probably heard some industry buzz about the recent investigations (and settlements) into risk adjustment fraud with several of the major insurers. United Health Group along with others, are accused of manipulating diagnosis codes to make patients appear to be sicker to achieve higher reimbursement outcomes via the Medicare Advantage program. Medicare Advantage allows providers to participate in a reimbursement model based on risk adjustment factor. Risk adjustment factor is determined by diagnosis complexity and specificity. Providers who treat patients that are sicker or have more chronic conditions are reimbursed at a higher rate per patient, regardless of actual health outcomes. This all relates back to the importance of understanding the False Claims Act and maintaining an ongoing internal compliance program. If you are still in the mindset of thinking accuracy with regards to reporting diagnosis codes is meaningless – Think Again!n
nnSmall practices could add points to their total performance scores in the merit-based incentive payment system and may qualify for an exemption from EHR requirements.nnMore small practices may qualify for exclusions from the Quality Payment Program (QPP), claim hardship exceptions from electronic health record (EHR) requirements, and earn automatic bonus points if the proposed QPP rule released June 20 is finalized.nnThe Centers for Medicare & Medicaid Services has proposed increasing two low-volume thresholds that would grant additional exclusions in 2018:n
nnEmotional Intelligence (EI) – Many of us are familiar with IQ tests, which measure our intellectual abilities and intelligence. Many of us also believe that having a high IQ makes you the best candidate for any job. However, employers are focusing more on emotional intelligence rather than academic aptitude. Emotional intelligence is the capability of individuals to recognize their own and other people’s emotions, discern between different feelings and label them appropriately, using emotional information to guide thinking and behavior, and manage and/or adjust emotions to adapt to environments or achieve one’s goal(s). EI can be a huge asset to employers because it is the one part of the human psyche that we can develop and improve by learning and practicing new skills. We’ve all met very clever and intelligent people who nonetheless had no idea about how to deal with people, and the reverse. How we manage ourselves and the relationships we have with others can have a lasting impact on future opportunities.
Check out this article regarding the announcement that Anthem has calmed controversy over Colorado’s health insurance by submitting its proposed plan for 2018 to the state. nnHealth insurance giant Anthem announced late Monday that it has submitted proposed 2018 plans to the state, easing fears that it might back out of Colorado’s health insurance exchange and leave residents of several counties without an insurance choice.nnBut an Anthem spokesman declined to provide specifics on those plans — including where the company expects to offer them — meaning it remains unclear if Anthem will continue to provide coverage to the same number of Coloradans it currently does.nnMonday was the deadline for insurers hoping to participate next year on the Connect for Health Colorado exchange to file their proposed plans and rates with the state Division of Insurance for review. The exchange is a one-stop shop for health insurance on the individual market — where people buy their own plans, instead of receiving coverage through an employer or the government.n