On Demand: Congenital Series, Part 1: Non-Invasive Diagnostic Services-Presentation Slides

Presentation Slides

Pdf Summary

The MedAxiom document, dated May 8, 2025, and authored by Jammie Quimby, provides a comprehensive guide on non-invasive diagnostic services for congenital heart defects (CHDs) and the related coding, supervision, and documentation protocols. The document underscores the prevalence of CHDs, affecting around 40,000 births annually in the U.S., with defects ranging from minor to severe. Various CHDs are detailed, including Atrial Septal Defect (ASD), Atrial Ventricular Septal Defect (AVSD), Coarctation of the Aorta (COA), Dextro-Transposition of the Great Arteries (D-TGA), and Hypoplastic Left Heart Syndrome (HLHS), among others.<br /><br />For diagnostic services, the document provides coding guidelines for echocardiography and other non-invasive cardiac imaging modalities. Echocardiography types include transthoracic, trans-esophageal, fetal, and Doppler echocardiography, each with specific CPT codes. The document emphasizes the importance of accurate coding and documentation to support medical necessity and ensure compliance with Medicare and CMS order requirements.<br /><br />It also explains professional components (PC) and technical components (TC) in medical billing, outlining the responsibilities associated with each and the use of modifiers to indicate billed services. Moreover, the guidelines address the difference between complete and limited echocardiography studies, and how these distinctions affect coding.<br /><br />The document delves into spirometry and cardiac computed tomography, outlining coding protocols and necessary documentation for these diagnostic tests. It specifies the coding strategy for pulmonary stress tests and oxygen uptake analysis as well.<br /><br />For ongoing cardiac monitoring, including ECGs, Holter monitors, and cardiac event monitoring, it provides detailed instructions on billing and service periods. The nuances between remote and in-person interrogations versus programming of implantable cardiac devices also receive significant attention, establishing rules for coding and reimbursement across different service periods.<br /><br />Overall, this MedAxiom guide is an essential resource for healthcare professionals involved in the coding and revenue cycle management of congenital heart defect diagnoses and treatments, ensuring compliance with best practices and payer requirements.

Keywords

MedAxiom

congenital heart defects

diagnostic services

echocardiography

medical coding

billing protocols

cardiac monitoring

documentation

Medicare compliance

Jammie Quimby