This article will cover some basic concepts related to modifier use, with an emphasis on how they are used in cardiology-specific applications. In addition to modifiers that are specific to cardiology, we will also review how some more general modifiers are used uniquely within the field.

What Are Modifiers?

As the name implies, modifiers are additional codes that are used in medical billing to add information to procedure codes, modifying their meaning. The variety of modifiers is one reason that they can be so confusing, with codes being used for everything from different sides of the body to the reasoning behind evaluations.

Misusing modifiers can carry heavy penalties and should be avoided at all costs. Although all coding and billing staff should be familiar with modifiers at a general level, you should always make sure that your staff is especially knowledgeable about the modifiers that your practice uses heavily.

There are many, many modifiers that each practice will use, but the following are most likely to be used by cardiologists.

Modifiers LAD, RCA, and LC: Artery Location Codes

Most medical specialties have a few modifiers that only they use, and for cardiology those are LAD, RCA, and LC. These stand for left anterior descending, right coronary artery, and left circumflex respectively.

There are very specific rules surrounding the use of these modifiers. When multiple vessels are operated on, your team must only code the highest-value vessel when adding on the relevant artery location modifier. When other vessels are operated on, they must use an “each additional vessel” CPT code, which will be discussed below.

This will vary depending on the procedure, and your team should understand which procedures have these codes available. For example, the CPT code 92995 refers to percutaneous transluminal coronary atherectomy. The relevant vessel modifier must be added to this code, after which 92996 will be used for each additional vessel, without the modifier present.

Although the modifiers themselves are simple — just use the one for the relevant vessel — the way that they fit into more complex coding situations can be a source of errors for the uninitiated.

Each Additional Vessel Codes

Although they aren’t modifiers, cardiology billing also heavily relies on the unique structure of each additional vessel codes. As the name indicates, these codes are used when the same procedure is performed on more than one vessel. Rather than using the same code, you must use an additional vessel variation.

As an example, there are two codes used for Intravascular coronary flow reserve measurement. The initial procedure will use code +93571, while each additional vessel will use +93572. This structure is mirrored for many procedures, and is also used in reference to additional branches for stent placement.

Modifier 59: Uncommon Bundling

Modifier 59 is used to note that certain services that are not usually bundled or performed together have been performed in the same visit. This modifier is very commonly used, but should only be used when no other modifier is appropriate. Because there are many other modifiers that describe relationships between procedures, it can sometimes seem like an easy fix to use modifier 59 indiscriminately.

This modifier can come into play in any discipline that relies on complex systems, procedures performed on multiple body parts as part of the same treatment plan, and extensive courses of testing. Although it is essential for all medical specialties, cardiological practices should make sure their billing department understands modifier 59 and its alternatives very well, so no billing errors creep in.

Modifier 91: Repeated Testing

Modifier 91 is another modifier that has very general uses but can be misused easily. This modifier is supposed to be used when a service is repeated on the same day and during the same visit. However, it should not be used if the service is repeated due to bad samples, malfunctions, or other issues.

Instead, this modifier is used in situations where samples need to be taken repeatedly to monitor an ongoing reaction to treatment, or the same procedure is performed as part of a unique treatment plan that doesn’t have a specified code. Because there are many types of repetition-based codes out there, making sure to use modifier 91 properly can be tricky for inexperienced billers.

Modifier 25: Evaluation and Management Bundling

Modifier 25 specifies that a distinct evaluation and management service was performed on the same day as another. This has very general applications and is one of the modifiers that can be used in place of modifier 59 when services are rendered together.

This is common in a cardiological setting as testing and further action can often follow evaluations during the same visit, although both are billed distinctly. If a patient comes in for an office visit and is subsequently sent for some type of test administered by the same doctor, modifier 25 can be used to note the distinction.

This modifier is commonly misused for services that have a different type of relationship, such as postoperative care. This is one reason that understanding modifiers is so difficult; although the definition of the modifier seems to include postoperative care, other modifiers better encapsulate that situation and should be used instead.

Outsource Your Cardiology Medical Billing

Give yourself one less thing to worry about by outsourcing your cardiology medical billing. With outsourced cardiology medical billing you no longer have to worry about multiple procedure reductions and keeping your staff trained up to the latest medical billing protocols. Plus, get the benefits of maximized payments and easier audits. Contact us to learn more about outsourcing your cardiology medical billing.

Telemedicine has expedited a shift to virtual medical professionals. As technology has improved and the onset of the coronavirus pandemic made changes necessary, more patients than ever before saw medical professionals virtually in 2020 and 2021.

The benefits of working with a virtual RN are becoming more clear, whether doctors shift back to in-person patient care or continue practicing telemedicine. Working with virtual RNs can save you money and free up your time, among other benefits.

What Virtual RNs Can Provide

Whether you’re looking for scheduling, administrative support, or medical scribe work to be completed, working with virtual RNs gives you access to a skilled professional who can adapt to the needs of your practice.

Live In-Room Charting

You can bring your virtual RN with you into the patient exam room where they will live-chart the visit in real-time in the doctor’s EMR of choice.

Medical Transcription

Virtual RNs can function as virtual scribes for doctors. On a computer or a tablet, a doctor can connect with a virtual RN via videoconferencing software.

Another option is to record dictation and upload it to a cloud server. A virtual RN can then transcribe it, even adding it directly into the patient’s chart.

Scheduling

Another benefit of virtual RNs is that they can be connected to your phone system even though they’re not sitting in your office. This allows them to both receive and place calls as if they were sitting at your front desk. They can interact with patients over the phone to both schedule and confirm appointments. They can even call insurance companies on your behalf.

Referrals, Phone Calls, and Administrative Tasks

It isn’t just the doctors that virtual nurses can assist. They can also make a difference in the front office with a doctor’s administrative staff.

Virtual RNs can assist with the following administrative tasks:

• Authorizations: Virtual Registered Nurses (RNs) can help in obtaining prior authorizations from insurance companies for medical procedures, treatments, or medications. This involves navigating the often complex and time-consuming process of securing approval from insurance providers before a patient receives certain healthcare services.
• Managing Medical Records: These professionals can organize and maintain patient medical records in digital systems, ensuring accuracy, confidentiality, and compliance with healthcare regulations. They may also assist in retrieving and updating medical histories, test results, and treatment plans as needed, facilitating seamless coordination of care among healthcare providers.
• Medical Billing: Skilled personnel can support medical billing processes by accurately coding diagnoses, procedures, and services provided to patients. They may help ensure that billing information is correctly documented and submitted to insurance companies or patients for reimbursement, minimizing errors and maximizing revenue for healthcare facilities or practices.
• Refilling Prescriptions: Experts can handle prescription refill requests from patients or pharmacies, verifying medication orders, reviewing patient records for medication history and allergies, and coordinating with healthcare providers to authorize refills as appropriate. This helps streamline medication management and ensures patients receive timely access to their prescribed medications.
• Eligibility: Professionals can verify patients’ eligibility for healthcare services or insurance coverage by confirming demographic information, insurance status, and coverage benefits. This helps prevent billing discrepancies and ensures that patients receive the appropriate level of care based on their insurance coverage or financial circumstances.
• Insurance Verification: Trained personnel can verify patients’ insurance coverage, including confirming policy details, coverage limitations, and copayments or deductibles. This information is crucial for healthcare providers to accurately bill insurance companies and patients for services rendered, avoiding claim denials or patient financial burdens.
• Referrals: Knowledgeable staff can assist in coordinating referrals to specialists or other healthcare providers by liaising with referring physicians, obtaining necessary medical records or test results, and scheduling appointments for patients. This helps ensure timely access to specialized care and promotes continuity of treatment for patients with complex healthcare needs.

Virtual RNs can also handle both verifying insurance eligibility and prior authorizations for a patient in order to make medical billing a lot easier. Any administrative staff you have will be busy working with patients. A virtual nurse can take care of these tasks to free up your time and your administrative staff’s time.

A virtual RN can chart a patient in real-time during an appointment, but that’s not the only paperwork they can handle. From transcribing dictations to filling out forms, virtual RNs can ensure that your documentation is filled out and uploaded to a cloud server for easy access.

Checking Patients In and Out

Even though a virtual RN isn’t in the office in person, they can take care of checking patients in and out. A tablet set up at a check-in station will offer patients access to the virtual nurse who can check them in and ensure all paperwork is filled out and up-to-date. Patients can check out the same way. A virtual RN can ensure that any follow-up appointments are scheduled and that patients have paid any fees for their appointment.

Custom Office Needs

Chances are, if your office has a specific need then a virtual RN is the solution. Working with a company that specializes in virtual RNs can help you develop your team in whatever way you need. VirtualRNs, for example, will train the VRN personalized to your requests.

The Benefits of Working With VRNs

Working with VRNs allows you to easily manage and scale your practice at an affordable rate, saving you time, money, and headaches. Hiring a VRN through a virtual RN hiring company will allow you to easily fill in gaps in your workflow, making your team’s processes easier and quicker.

How the Hiring Process Works

You’re probably familiar with the hiring process for a nurse who will work with you in person in your practice. But introducing a virtual RN into your workflow may prove to be a more confusing process. Although, it doesn’t have to be.

When you work with a virtual RN company, the company will present you with profiles of hand-picked candidates. You will then select the virtual registered nurse who best fits your needs. This will be the VRN who works with you on a daily basis—no stress from working with a brand new nurse every day.

From there you will connect with your new VRN, setting them up as needed with your software and processes. Set an official start date and begin working with them on a set daily or weekly schedule—just as you would with a nurse working in the office.

Addressing Concerns

Most doctors have worked almost entirely with an in-person team of nurses. Introducing a virtual team member into long-standing workflows can be concerning. Concerns like costs, HIPAA compliance, and training are all reasons you may be second-guessing the switch to virtual.

HIPAA Compliance

Solution: Virtual RNs from VirtualRNs.com are all trained in HIPAA compliance.

HIPAA compliance is incredibly important, especially when working with contractors and employees. Be sure the company you work with supplies virtual RNs who have certificates in HIPAA training, have a background check, and sign a Business Associate Agreement (BAA).

Cost

Solution: Virtual RNs from VirtualRNs.com are $11 to $12 per hour.

Working with virtual RNs will cost you on average $12 an hour for a part-time nurse clocking 15 to 30 hours weekly. A full-time virtual RN working over 30 hours a week will cost $11 an hour. This is a far cry from the $36.66 per hour national average RNs are paid in the United States. Not including the additional costs of hiring on an employee.

Training

Solution: Virtual RNs from VirtualRNs.com are trained in the tools your practice already uses.

Depending on the virtual RN company you choose, virtual RNs will be trained to use the tools you currently have in your workflow. If you work with a company like VirtualRNs you will be working with registered nurses with no less than two to three years of experience on average. These nurses will be trained to use the systems you currently use in your practice and will be familiar with using tools like BOX.xom, Updox, RingCentral, AdvancedMD, and other programs.

Taking the First Step to Hire Your Virtual RN

You’ll want to start the process of hiring a virtual RN through a reputable company that can not only be flexible to your needs but also provides skilled nurses. Make sure you do your research to find both the highest quality virtual RNs and the best price per hour. Companies like VirtualRNs provide staffing solutions that are focused on quality and cost-consciousness.

Virtualrns.com

Virtualrns.com is a company that offers virtual RN services for doctor’s practices. They offer reliable virtual nurses at a cost that can save doctors money on staffing. Their virtual nurses can help doctors stay organized as well as free up the doctor’s time so they can focus their time and attention where it matters most: on the patients.

When it comes to choosing an electronic medical records (EMR) system, the big question for many is whether to go with cloud-based or server-based. There are advantages and drawbacks to both options. Be sure to thoroughly research your options so that you make the best choice for your company.

What Is the Difference Between Cloud-Based EMR and Server-Based EMR Systems?

Cloud-based EMR systems are hosted in the cloud rather than hosted by an on-site server. This means that all of the data for the system is stored in the cloud and is accessible from anywhere via the internet. This also means that the system is dependent on the vendor’s cloud infrastructure rather than an on-premise environment.

By contrast, a server-based EMR system is hosted on-site by your practice or company. You have more control over its infrastructure, but also bear more of the responsibility for maintaining and managing the system.

But what are the advantages and disadvantages of each type of system?

Cloud-Based EMR

The cloud is a major part of our lives. Many people store files in the cloud for convenient access. It’s also becoming more and more common in the business world as more software vendors are offering cloud-based services. But is cloud-based EMR the right choice for your practice?

Pros of a Cloud-Based EMR

The advantages of a cloud-based EMR system include:

• Cost-effective for small and solo practices
• Easy to set up
• No software installation necessary
• No hardware purchasing necessary
• No hardware maintenance necessary
• Better customer support
• Fewer or lower licensing costs
• Sophisticated security for data protection
• Practices don’t have to meet HIPAA requirements if the vendor does
• Easier transition from one system to another
• The vendor has more responsibility than the practice does to meet Meaningful Use requirements
• Accessible from anywhere
• No in-house IT staff required

Cons of a Cloud-Based EMR

However, cloud-based EMR systems also have their drawbacks:

• Practices must rely on the vendor for security and backups
• There may be lag time accessing remote servers
• Over time, cloud-based systems can be more expensive
• All patient data is controlled by the host
• Higher risk of compromised patient data
• Customization may be limited
• A steady internet connection is required
• If a vendor closes, all data could be lost
• The practice’s bandwidth may limit software speed
• Your access speed may depend on your location

Server-Based EMR

A server-based EMR hosted on-site can offer some major advantages to practices that have the resources to maintain them. However, smaller practices or solo practices may not find them feasible because of the resources required to install and maintain them.

Pros of a Server-Based EMR

Some advantages of a server-based EMR include:

• Speed is based only on internal infrastructure
• Connection is not reliant on external factors
• High-quality images can be downloaded quickly
• Full control over all data
• Data is protected from unforeseen external threats

Cons of a Server-Based EMR

On the other hand, there are some disadvantages to server-based EMR systems:

• Up-front costs can be higher
• Licensing fees can be expensive
• Server hardware must be installed
• IT staff required to install and maintain the system
• Updates and maintenance are the practice’s responsibility
• Compliance with regulations is the responsibility of the practice
• HIPAA compliance is the practice’s responsibility

Is a Cloud-Based or Server-Based EMR Better for My Practice?

There are benefits and drawbacks to both types of EMR systems. What it comes down to for many practices is size and cost. A cloud-based system often has fewer up-front costs, even though it may cost more in the long run due to monthly or yearly subscription fees. A cloud-based system also doesn’t require IT staff to manage and maintain an on-site server. Larger practices may have the resources to invest in both on-site hardware and the IT staff necessary to maintain a server-based EMR system.

All practices looking for EMR software should research their options in advance and look at what type of system will best meet their needs without impacting how their practice runs.

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