A DAY in the LIFE of a SPECIALTY CODER – Cardio, EP, CardioThoracic
(name withheld at the request of the author)
I code for Cardiology, Electrophysiology and Cardiothoracic surgery. I work from home a few days a week and go to the clinic one day.
I was coding FP/IM for 6-months when I was told that I need to start learning EP. The providers were helpful, however, there was a lot of research both in the clinic as well as out of the clinic. The same thing happened to me with cardiology, cardiothoracic I had a wonderful mentor. All of these specialties have challenged me and continue to challenge me, however, I like learning new things and it keeps my mind sharp and from getting board.
I have quota of 180 sessions per day, some days I do not make that due to the complexities of the surgeries I code. If I were doing FP/IM my quota would be 200.
Working from home:
I start with checking my emails, if there is a pre-auth request I have to read the orders, review the notes to see what type of device (internal cardiac defibrillator, pacemaker, or loop) and send the codes with dx codes to the pre-auth dept. I answer whatever else is needed.
I run reports so I am able to reconcile the surgeries and procedures. I have 5 work queues I am responsible for, so I transfer everything where I need them so I could code them later in the morning.
I go into my denials and transfer any patient concerns or denials to my worklist. If there are Medicare denials and a corrected claim is needed I could send those out the door after the correction. If the denials are commercial payers, I have to ‘pend’ them until I can get to the clinic.
Once I have everything where I need it to be, I start to work the work queues. I have approximately 500 claims between the office visits, labs, procedures and surgeries.
I will read the documentation, write down the codes I come up with, the majority of the time my coding matches my providers coding. If it does not match I will sent him / her an in-basket message, if I don’t hear from them I will print the report once at the clinic to ask their opinion. Once I have the correct codes I plug them into Vital Ware to check for CCI edits and add appropriate modifiers if needed.
This specialty I code CABG’s, valve replacements, lobectomies, lung wedges / VATS, TAVR’s and AAA along with anything else that may come up. The majority of these surgeries have 90-day global periods.
The office visits I code, they also usually have device checks and EKG’s done at the same time. I need to know the frequency guidelines and global periods for the device checks. The procedures that are coded are EP studies, ablations, ICD / PPM / Loop implants. The implants have certain criteria for billing so I need to be sure I have everything according to payer policy. Once I have all the codes that are being billed, I plug them into Vital Ware, also add appropriate modifiers and verify the dx.
Cardiology / Peripheral-
I work at caths, office visits, as well as TAVR’s and cardiomems. There are no global periods unless they are doing a loop implant. Again, with the caths I need to look at the policies as there are certain diagnoses that are required for payment. Once I have all the codes that are being billed, I plug them into Vital Ware also add appropriate modifiers and verify the dx.
Working in the clinic-
First things, check emails, move sessions to correct work queues, pick up paper billing.
I go into the denials and work them, I will have to draft a cover letter, prepare outlined notes where I came up with the codes along with supporting documentation for the payers. Sometimes the payer will request a prepayment review for the high dollars surgeries; I still send all supporting documentation with a cover letter.
I will then code the paper billing, which typically takes the majority of the day. I will either scan them to me or wait until the following week to enter to the system; working at home absolutely no patient information is allowed.
Once the providers come in, I will make my rounds to say hi and ask if they need anything, or ask my questions that need answers prior to coding / billing. There are days where several providers have questions for me so I spend a couple hours talking with / helping them. If I see documentation needs tweaking for HCC or to show medical necessity so the reports can stand alone I educate.
I also continuously look at the LCD’s to see if there are any updates that I have missed in my email. I educate the physicians if there are updates.