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Cardiology, MACRA and structured reporting

March 31, 2017
From the March 2017 issue of HealthCare Business News magazine

Structured reporting plays a critical role in data integrity by driving comprehensive documentation. It helps ensure that every procedure report contains all the requisite data elements captured in standard formats and removes the variability that limits adoption of evidence-based practices that guide appropriate treatment. This allows information in the patient record to be queried to better understand treatments provided and identify any issues that may influence future care decisions, and helps clinicians determine if the care processes and protocols in place are appropriate — all of which leads to improved patient outcomes, enhanced compliance and more accurate coding for appropriate reimbursement.

Recouping millions
The impact of subpar documentation in the form of dictation or unstructured reports on coding alone can be millions of dollars for the average cardiology service. Consider the results of a recent study by Wolters Kluwer and MedAxiom Consulting exploring the relationship between facility and physician practices. A comparison of coding practices in 101 cases in five regional community hospitals revealed that half of physicians and slightly more than half of facilities coded incorrectly, resulting in significant risks of under- and over-billing.

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Anecdotal evidence suggests that coding errors result from the methods employed to collect data post-procedure. Physicians typically dictate procedures verbally, which are then transcribed and sent back to the physician to review. Coders then turn those reports into CPT codes to submit for payment. Facilities have a similar procedure, documenting procedures as they happen and turning them into charges or codes that translate to APC codes which are then submitted for payment.

Wolters Kluwer, in partnership with MedAxiom, sought to quantify these suspicions by determining the accuracy of current coding practices in the cardiology setting. Researchers audited 101 procedure notes to compare the outpatient procedure documentation to the associated facility and physician professional service CPT codes selected for billing. A multi-state health care system provided five sites for analysis, each of which was asked to select two interventional cardiologists who performed both coronary interventions (PCI) and interventional peripheral vascular (PV) procedures. Five PCI cases and five PV cases were provided for each selected interventionist, for a total of 20 patient cases from each site.

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