Learn how hbRecon helped one IDN recover hundreds of thousands of dollars in missed revenue for IVL procedures by performing a coordinated data audit.
Intravascular lithotripsy (IVL) is a novel procedure used to aid in the treatment of severely calcified coronary artery disease. As IVL procedures have grown in utilization since FDA approval in 2021, hospital coding departments often struggle to document the correct utilization for each patient, especially as Medicare continues to shift its coding guidelines to ensure proper reimbursement.1 Utilizing heartbase’s hbRecon Toolkit, one integrated delivery network (IDN) seamlessly navigated the recent Medicare IVL coding changes, identifying over $300,000 in services that would have otherwise gone unbilled.
Implementing new coding guidelines is a critical challenge for cardiac services billing departments. Whether a coder is unaware of the specific changes or fails to recognize how these changes apply, the end result is a missed code and limited reimbursement. A 2023 report from Shockwave Medical, the pioneer in IVL technology for coronary procedures, describes the most recent Medicare coding guideline changes for IVL:1
Turning Missed IVL Codes Into Six-Figure Revenue
“Starting October 1, 2023, three new Coronary IVL-specific Medicare Severity Diagnosis Related Group (MS-DRG) codes have been established for Percutaneous Coronary Intervention (PCI) procedures involving Coronary IVL in the hospital inpatient setting. The New Technology Add-on Payment (NTAP) for Coronary IVL will conclude on September 30, 2023.
Additionally, the final 2024 Medicare Inpatient Prospective Payment System (IPPS) rule consolidates the prior four MS-DRGs involving PCI with implant of a stent into two MS-DRGs, removing a previous distinction between stent type – Drug Eluting Stent (DES) or Bare Metal Stent (BMS). PCI with stent procedures utilizing alternative plaque modification therapies such as atherectomy, cutting or scoring balloons without the adjunctive use of IVL will map to PCI MS-DRGs 321-322.”
Shockwave Medical. (2021, February 16). Shockwave Intravascular Lithotripsy FDA Approved to Treat Advanced Heart Disease [Press release]. https://shockwavemedical.com/about/press-releases/shockwave-intravascular-lithotripsy-fda-approved-to-treat-advanced-heart-disease/
Despite significant changes to reimbursement structures, countless coding departments continue to operate on previous guidelines. As a result, this IDN missed IVL reimbursements from over two dozen procedures by failing to use the new ICD10-PCS codes. Leveraging the hbRecon toolkit, the IDN performed a coordinated audit to locate these discrepancies and identify where the IVL was miscoded in each claim. From October 2023 to February 2024, hbRecon identified 27 cases across nine sites with missed IVL codes, recovering hundreds of thousands of dollars in unbilled revenue.
Maximize Accurate CV Services Revenue With hbRecon
The struggle to properly capture and code IVL charges is just one example of the widespread challenge facing cardiac service coding teams in nearly every major hospital and health system across the country. To help close the gaps in coding and documentation coverage, hbRecon uses advanced software-driven tools to algorithmically analyze coding, clinical registry, and financial data, identifying mismatches and recommending proper Diagnosis Related Group (DRG) codes. hbRecon helps billing teams determine how to correct their coding and registry data, optimizing their processes to accurately reflect each episode of care and, ultimately, build a more profitable cardiac services department.
Sources
- Shockwave Medical. (2021, February 16). Shockwave Intravascular Lithotripsy FDA Approved to Treat Advanced Heart Disease [Press release]. https://shockwavemedical.com/about/press-releases/shockwave-intravascular-lithotripsy-fda-approved-to-treat-advanced-heart-disease/
- Coronary Intravascular Lithotripsy (IVL) & Percutaneous Coronary Intervention (PCI): 2024 Medicare Hospital Inpatient Reimbursement Coding and Payment Guide. (2023). Shockwave Medical. https://discover.shockwavemedical.com/hubfs/shockwave-medical/Coronary%20IVL%20Hospital%20Inpatient%20Coding%20Guide.pdf