Cardiac Resynchronization Therapy

Types of Cardiac Resynchronization Therapy(CRT-P / CRT-D) Coding

What is CRT?

Cardiac resynchronization therapy (CRT) is a newer generation of pacemakers and AICDs. Its distinguishing feature is an extra lead at the left ventricle, in addition to the leads at the right atrium and/or the right ventricle used with conventional pacemakers and AICDs.

CRT is also known as biventricular therapy because, with one lead at the right ventricle and another at the left ventricle, it coordinates the pumping action of the ventricles.

There are two types of cardiac resynchronization devices:

·        CRT-pacemaker (CRT-P)

·        CRT-defibrillator (CRT-D)

A cardiac resynchronization therapy pacing (CRT-P) system utilizes conventional pacing technology, but takes it one step further by adding a third lead, or electrode, to sense and pace the left ventricle.

The pacing device can then simultaneously stimulate both ventricles in synchrony with atrial activity. The synchronous contraction of both ventricles facilitates more adequate filling of the left ventricle and less backflow to the left atrium, resulting in more oxygenated blood being pumped to the body.

Cardiac resynchronization therapy has also been incorporated into automatic internal cardioverter-defibrillator devices (CRT-D), allowing for the simultaneous treatment of congestive heart failure with intraventricular conduction delays and the prevention of sudden cardiac death caused by life-threatening ventricular arrhythmias.

In physician’s operative notes, you may see CRT devices referred to as one of the following:

CRT-P

·        Cardiac resynchronization therapy pacemaker

·        Biventricular pacemaker

·        Bi-V pacemaker

·        Low power CRT

·        Heart failure pacemaker

CRT-D

·        Cardiac resynchronization therapy defibrillator

·        Biventricular ICD

·        Biventricular pacemaker with defibrillator

·        Biventricular pacing with defibrillation

·        High power CRT

·        Heart failure pacemaker with defibrillator

·        Heart failure pacemaker with ICD

Job Details

Inpatint Coding Job Details:

JOB DEFINITION: Under limited supervision, reviews medical records and performs coding on all diagnoses, procedures, (both medical and surgical), and assigns the correct diagnostic related grouping (DRG). Uses the most accurate codes for reimbursement purposes, research, epidemiology, statistical analysis outcomes, financial and strategic planning, evaluation of quality of care, and communication to support the patient’s treatment. Maintains the confidentiality of patient records and procedures.

ESSENTIAL FUNCTIONS: The following duties ARE NOT intended to serve as a comprehensive list of all duties performed by all employees in this classification. Shown are duties intended to provide a representative summary of the major duties and responsibilities. Incumbent(s) may not be required to perform all duties listed and may be required to perform additional, position-specific duties.

REPRESENTATIVE DUTIES: Responsible for abstracting, coding, and sequencing the classification of medical and surgical procedures, diagnosis, and treatment modalities on Inpatient and Day Surgery records. Selects the most accurate and descriptive codes from the listings of International Classification of Diseases, Ninth Revision, Clinical Modification, (ICD-9-CM American Medical Association Current Procedural Terminology (CPT-4) Coding system, and Healthcare Common Procedure Coding System (HCPCS). Assigns DRG’s and performs coding compliance reviews. Abstracts and codes pertinent medical data into multiple software programs. Follows official coding guidelines to review and analyze health records. Maintains compliance with both external regulatory and accreditation requirements, and with State and Federal regulations. Extracts pertinent data from the patient’s health record, and determines appropriate coding for reports and billing documents. Identifies codes for reporting medical services, procedures performed by physicians, and enters codes into computer system. Provides feedback and education to physician and professional staff regarding changes in coding methodology and enhanced documentation procedures for optimizing reimbursement. Utilizes the coding query process to providers to request missing information. Corrects records with inconsistent information and/or containing discrepancies. Provides training and mentoring to new employees as needed. Performs routine audits independently and participates in performance improvement. Participates in coding compliance plans, research and analysis, benchmarking, financial and strategic planning, and other customer requested project. Reviews and discusses informational requirements with individuals to determine the most expeditious method for data acquisition and availability of data. Retrieves and compiles data for reports as directed. Maintains the confidentiality of patient records and procedures. Performs other duties as assigned or required.

Knowledge and Skills

   KNOWLEDGE and SKILLS:

·        Knowledge of coding software.

·        Knowledge of medical terminology, abbreviations, anatomy and physiology; major disease processes and pharmacology.

·        Knowledge of classification systems, ICD-9-CM nomenclature, CPT-4 and HCPCS nomenclature, coding rules, guidelines and proper sequencing.

·        Knowledge of coding conventions and rules established by the American Medical Association (AMA), the American Hospital Association (AHA) and the Center for Medicare and Medicaid (CMS), for assignment of diagnostic and surgical procedural codes.

·        Knowledge of JCAHO, Privacy Act of 1974, and HIPAA standards affecting medical records and the impact on reimbursement and accreditation.

·        Knowledge of ethical coding principles and revenue cycle activities.

·        Knowledge of the principles and practices of medical file and record management.

·        Skill in reading medical records, and finding and resolving documentation discrepancies.

·        Skill in operating computerized medical coding and information processing systems.

·        Skill in operating a personal computer and utilizing a variety of software applications.

·        Skill in understanding medical/surgical coding procedures and protocols.

·        Skill in linking diagnosis to services and applying appropriate codes to diagnosis, procedures and supplies.

·        Skill in using analytical and research modalities skills to define and solve problems.

·        Skill in interpreting and applying ethical coding standards, federal and state laws and regulations; rules; policies and procedures; and professional practice standards for health care organization coding compliance program activities.

·        Skill in effective verbal and written communication with peers, physicians and other hospital staff.

·        Skill in writing reports and other materials.

·        Skill in oral communication and presenting information to providers.

Qualification

Medical Coding Job Qualification

MINIMUM QUALIFICATIONS: An Associate’s Degree in Health Information Management, AND two (2) years of medical/surgical coding experience; OR an equivalent combination of education and experience. Certified Coding Specialist (CCS) required. If no CCS applicant, will consider a Certified Coding Specialist-Physician (CCS-P), Certified Professional Coder-Hospital (CPC-H) and/or a Certified Professional Coder (CPC) with the understanding they will sit for the CCS exam within 1st year of employment.

ADDITIONAL REQUIREMENTS: May be required to work outside the traditional work schedule. According to the needs of the organization, some incumbents in this job class may be required to obtain specific technical certifications. Incumbent must pursue the CCS certification if not credentialed at the time of hire.

MINIMUM PHYSICAL REQUIREMENTS: The following demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. This position requires persistent repetitive movements of the hands, wrists and fingers and the ability to sit for long periods of time. ANMC is not a latex free environment. High stress, constant change due to 3rd party and CMS reimbursement rules and regulations. Therefore, some latex exposure can be expected. May occasionally be exposed to infectious diseases. The majority of work is performed with a wide variety of people with differing functions, personalities and

abilities.

AGE REQUIREMENTS: None.

This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.

Hospital Coding

Hospital (DRG) Coding:

            Diagnoses and procedures will be coded utilizing the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and/or other classification systems that may be required Company facilities will follow the most current Official Guidelines for Coding and Reporting diagnoses and procedures published in AHA Coding Clinic for ICD-9-CM.