In the complex world of healthcare, coding is much more than a mundane administrative task. It’s an art form that, when mastered, can unlock significant revenue potential, streamline operations, and ensure the financial health of vital programs—like those dedicated to stroke care. In this blog, we’ll explore the critical role coding plays in maximizing the finances of a stroke program.
The Hidden Revenue Potential in Coding
Many healthcare providers and administrators overlook the financial power of accurate and strategic coding. The assumption that “stroke never makes any money” is a common misconception. The truth is, with the right coding practices, the financial performance of stroke programs can be significantly improved. This is especially important as we move from Primary Stroke Centers (PSCs) to Thrombectomy-Capable Centers (TCCs) and Comprehensive Stroke Centers (CSCs).
Hospital & Physician Coding Tips for Maximizing Reimbursement
There are various nuances in hospital and physician coding for stroke services, particularly for interventional procedures, but here are a few coding strategies to ensure maximum reimbursement is realized:
Hospital Coding
Accuracy in Diagnosis Coding:
- Ensure that stroke diagnoses include sufficient supplementary information to move beyond unspecified codes like I63.9. It’s essential to ask whether the stroke is current and if there’s documentation supporting a more specific diagnosis.
- Coding history of cerebral infarction (stroke) versus cerebral infarction with residual deficits and coding the stroke as current when it is not. Acute stroke is only coded during the initial episode of care.
- Misclassifying a transient ischemic attack (TIA) as a stroke
- Failing to differentiate between nontraumatic and traumatic hemorrhages
Understand DRG Impact: DRG assignment directly affects reimbursement. For instance, strokes with major complications or comorbidities (MCC) have different financial implications than those without. Additionally, if your hospital implants the LINQ device in a stroke patient that receives tPA only, then the DRG assignment may change from DRGs 61-63 to DRGs 40-42 resulting in a DRG payment reduction of $3,000-$5,000 per case.
Physician-Based
- Bundling issues of mechanical thrombectomy procedures. For example, both angioplasty (61630) and stent placement (61635) CPT codes bundle into thrombectomy/infusion (61645)
- Errors with recognizing intracranial versus extracranial carotids
- Noting the wrong side or the wrong vascular territory. For example, 61630, 61635, and 61645 are not unilateral or bilateral codes. They are based on vascular territory, not laterality. As it relates to vascular territory, 61630, 61635, and 61645 may only be reported once per vascular territory.
Proactive Measures to Ensure Financial Success
Taking proactive measures can help prevent errors, maximize revenue, and ensure that your stroke program operates efficiently. Below are key strategies to ensure proper coding:
- Advanced Coding Software and Tools: Investing in advanced coding software and tools can make a substantial difference in the accuracy and efficiency of your coding processes. These tools often come equipped with built-in guidelines, prompts, and validation checks that help coders select the most appropriate codes and avoid common errors.
- Conduct Regular Audits: A third-party coding audit can reveal inconsistencies and errors that might be costing your program money. Regular audits help maintain high standards and ensure that your coding practices are aligned with the latest guidelines and policies.
- Utilize a Financial Dashboard: To track and optimize the financial health of your stroke program, implementing financial dashboards is essential. These dashboards should measure key metrics such as volume, case mix, length of stay (ALOS), charges, payments, direct costs, and contribution margins.
- Other Measures: Providing continuing education to physician and coding teams and employ a credentials Interventional Radiology (IVR) coder (e.g. AAPC CIRCC®) will
The Bottom Line
The financial success of a stroke program hinges on more than just clinical excellence. It requires a keen understanding of the coding process, strategic financial planning, and continuous improvement. By mastering the art of coding and leveraging the right financial tools, healthcare providers can unleash the hidden revenue potential of their stroke programs, ensuring sustainability and growth in an increasingly challenging healthcare environment.
Remember, in the world of healthcare finance, as the saying goes, “No margin, no mission.” By focusing on these key areas, you can ensure that your stroke program not only survives but thrives, delivering the best possible care to patients while maintaining financial health.
If you’re looking to dive deeper into the financial management of stroke programs, Corazon offers tailored consulting services to help healthcare organizations and providers maximize their revenue potential.
