Q&A: Charging for cardiac catheterization procedures

Wednesday, October 9, 2019

Q: We are in the middle of changing the hospital methodology for charging cardiac cath procedures within Epic CUPID. What is your hospital’s workflow for charging cardiac cath procedures? Is it by:

  • Time increments? HIM provides CPT® codes according to documentation and integrates them to the charge?
  • Procedure? Each CPT code is detailed with specific charge and the department posts? Does HIM validate accuracy?
  • Procedure? Each CPT code is detailed with specific charge, and HIM posts it based on documentation?

A: We use the McKesson system for our cath lab. We tried a multitude of processes but have nailed one down after our initial year of implementation. Currently, our audits have found that our coding accuracy is at 100%.

We hard coded all our procedures for the cath lab, whereas previously we were soft coding. I have measured each CPT code against the fee schedule for Medicare to ensure our pricing is capturing the full potential of our reimbursement. The clinical department is where the most training was needed, as we rely upon the staff to drop the appropriate procedure charge for what was performed. Our HIM department reviews documentation, then validates whether we have the correct CPT codes and charges. If not, then HIM communicates with my revenue integrity staff, and my staff will drop the appropriate charge so that it doesn't have to go back to the cath lab for review. Revenue integrity then reviews for devices, to make sure we have captured all the documented stents, caths, or pacemakers for the procedure. If any of the supply charges are missing, we contact the cath lab to ask them to drop the charge for the devices.

None of the CPT codes for cath lab are time based. Also, some diagnostic procedures reimburse around $2,500, so we didn't want to have any time-based charges skyrocketing our contractual adjustments. 

Editor’s note: This question was posted in the Chargemaster and Charge Capture section of the NAHRI Forums.

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