Navigating Medicare Coding Changes to Maximize IVL Revenue Capture


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.

Reach out to learn more about how hbRecon can help your facility eliminate coding gaps and maximize reimbursements for cardiac services.

Sources

  1. 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/
  2. 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 

Heartbase, Inc. Officially Supports the STS Adult Cardiac Beta Blocker & General Thoracic Neo-Adjuvant Supplemental Forms


CHICAGO, IL – We are excited to announce that heartbase™ officially supports the STS Adult Cardiac Beta Blocker Supplemental Form for v4.20.2 and General Thoracic Neo-Adjuvant Supplemental Form for v5.21.1. On April 30th, heartbase clinical specialist Carmen Ernst, RN, BSN, will hold a special training class covering the ins and outs of these optional updates. Heartbase customers can click here to register.

From the STS:
“Advances in medicine, technology and research interests has generated the need for The Society of Thoracic Surgeons (STS) to collect additional data from sites related to the already existing registries: Adult Cardiac Surgery Database (ACSD), General Thoracic Surgery Database (GTSD), and Congenital Heart Surgery Database (CHSD). This information is needed in a timely manner and cannot wait until the registries have completed a full data specification upgrade. To facilitate obtaining this data as soon as possible, the STS is providing REDCap web pages and is asking sites to voluntarily use these forms for recording the supplemental data.

Many sites have expressed the desire to not have to switch to a different platform for recording any additional information, preferring to keep all data entry within their current vendor software. For this reason, STS is making the specifications for these data collection forms available to software vendors who are already certified on the latest versions of each registry so the new fields can be incorporated into their existing software. There is no requirement from the STS for vendors to incorporate these fields into their software and doing so is completely voluntary.”

Participation using hbCOR offers:

  • A single location to capture and audit both standard and supplemental STS ACSD & GTSD variables.
  • Ability to run AD HOC reports using the hbQuery Tool for the supplemental fields.
  • Facilitated submission to REDCap – vendors must submit the supplemental data to the STS on behalf of the organization.

Please contact the heartbase Sales Team (sales@heartbase.net) with any questions about adding this optional form to your heartbase hbCOR instance.


About heartbase, Inc.

Heartbase™ is a privately-held company founded in 1992 and designed to be intuitive & centered on the needs of the clinician. Since our inception, we have known that the most effective way to develop a robust and reflexive software platform is through collegial partnerships with our clinical & financial users. Working directly with our customers – listening to their concerns and honoring their suggestions for improvement – allows us to build a tool that is fast, efficient, and tailored specifically to the individual needs of each healthcare institution.

Our primary major business lines are the following: hbCOR, Data Capture & Reporting; hbAnalytics, Realtime Clinical & Financial Dashboards; hbRecon, Coding Reconciliation & Revenue Generation; & hbNote, Data First Structured Reporting.

Heartbase, Inc. Certified in ACC-NCDR Chest Pain – MI v3.1


CHICAGO, IL – As of June 30th, 2023, we are excited to announce that heartbase™ is officially certified by the ACC-NCDR for Version 3.1 of the Chest Pain – MI Registry Database. Heartbase users, please visit the heartbase hbKnowledgebase to view the recording of Carmen Ernst’s walkthrough of this new version – please click here. The heartbase staff highly recommends that users view the recording, as this version change was substantial in scope.

From the ACC-NCDR website:

“For more than a decade, the Chest Pain – MI Registry™ has been the single, most trusted source for outcomes-based, continuous quality improvement and remains the go-to registry for hospitals and health systems applying American College of Cardiology (ACC) and American Heart Association (AHA) clinical guideline recommendations.”

Participation offers:

  • Integration & Interoperability with other heartbase hbCOR registry events.
  • Interoperability options from other hospital systems, such as Epic Clarity, to allow for the pre-population of discrete fields.
  • A comprehensively streamlined & customizable electronic DCF, improving upon the flow and functionality of the ACC Online Tool, with options such as role-based access.
  • Simplified reporting with the hbQuery Tool, with measure reporting and other standard reports to follow.
  • Integration with the hbRecon Module to ensure CP-MI cases are correctly coded and billed, maximizing reimbursement.
  • Planned hbAnalytics updates to include new measure reporting and associated breakout reports.

If you’re a CP-MI data manager or abstractor and would like to take a look at our new forms, please contact heartbase Client Account Manager Alex Potanos to schedule a review session. 

About heartbase, Inc.

Heartbase™ is a privately-held company founded in 1992 and designed to be intuitive & centered on the needs of the clinician. Since our inception, we have known that the most effective way to develop a robust and reflexive software platform is through collegial partnerships with our clinical & financial users. Working directly with our customers – listening to their concerns and honoring their suggestions for improvement – allows us to build a tool that is fast, efficient, and tailored specifically to the individual needs of each healthcare institution.

Heartbase, Inc. Certified in STS CHSD v6.23.2

CHICAGO, IL – We are excited to announce that heartbase™ is officially certified by the STS  for Version 6.23.2 of the STS Congenital Heart Surgery Database. On June 13th, 2023, at 2 pm CT, heartbase clinical specialist Carmen Ernst, RN, BSN, will hold a special training class covering the ins and outs of this version. Heartbase customers can click here to register.

From the STS website:

“The STS Congenital Heart Surgery Database (CHSD) is the largest database in North America dealing with congenital cardiac malformations. The CHSD contains more than 600,000 congenital heart surgery procedure records and currently has more than 1,000 participating physicians, including surgeons and anesthesiologists.”

Participation offers:

  • A standardized format for data collection to assess the care of patients undergoing congenital cardiothoracic procedures.
  • Semi-annual performance outcomes reports in a format that allows comparison of local outcomes against national standards.
  • An optional anesthesiology component, which enhances data collection and quality assessment for improving the care of patients undergoing cardiothoracic procedures and surgery.
  • Analysis of major outcomes and process-of-care measures that impact congenital heart surgery patients.
  • Complexity scoring to evaluate the clinical characteristics of your practice.

If you’re a CHSD data manager or abstractor and would like to take a look at our new forms, please contact heartbase Client Account Manager Alex Potanos to schedule a review session. 

About heartbase, Inc.

Heartbase™ is a privately-held company founded in 1992 and designed to be intuitive & centered on the needs of the clinician. Since our inception, we have known that the most effective way to develop a robust and reflexive software platform is through collegial partnerships with our clinical & financial users. Working directly with our customers – listening to their concerns and honoring their suggestions for improvement – allows us to build a tool that is fast, efficient, and tailored specifically to the individual needs of each healthcare institution.

Our primary major business lines are the following: hbCOR, Data Capture & Reporting; hbAnalytics, Realtime Clinical & Financial Dashboards; hbRecon, Coding Reconciliation & Revenue Generation; & hbNote, Data First Structured Reporting.

Heartbase, Inc. Certified in STS/ACC TVT v3


CHICAGO, IL – We are excited to announce that heartbase™ is now officially certified by the ACC-NCDR for Version 3 of the STS/ACC TVT Registry Database.

Highlights of the heartbase™ TVT module include:

  • Integration & Interoperability with other heartbase™ registry events.
  • Interoperability options from other hospital systems such as Epic Clarity, allowing for pre-population of discrete fields.
  • A comprehensively streamlined & customizable electronic DCF, improving upon the flow and functionality of the ACC Online Tool, with options such as role-based access.
  • Simplified reporting with the hbQuery Tool, with measure reporting and other standard reports to follow.
  • Planned integration with the hbRecon Module to ensure TVT cases are correctly coded and billed, maximizing reimbursement.
  • Planned hbAnalytics update to include measure reporting and associated breakout reports.

If you’re a TVT data manager or abstractor and would like to take a look at our new forms, please contact heartbase Client Account Manager Alex Potanos to schedule a review session. Previously led group demonstrations were recorded, and are available on the hbKnowledgebase.


About heartbase, Inc.

Since 1992, heartbase™ has provided health care centers with the most technologically innovative and clinically intuitive data management and analytic solution in the industry. Working collegially with its immense network of users, heartbase™ has created a vast library of reporting tools that provides its clients with complete control of their hospital-owned clinical data. Heartbase’s revolutionary hbCOR platform propels clinical performance, aligns clinical data with registry requirements, and unites health care systems from across our network to the most comprehensive reporting repository in the industry.

Heartbase, Inc. Certified for ACC-NCDR Auxilary Dataset Shockwave Intravascular Lithotripsy (IVL) Dataset for Collection & Submission


CHICAGO, IL – Heartbase is officially certified for the ACC-NCDR Auxiliary Shockwave Intravascular Lithotripsy (IVL) Dataset v1.0 for the CathPCI registry. This optional update has been included as part of the hbCOR v7.5.02 update package, no additional downtime will be required for sites that are interested in participating.

Highlights of the heartbase ACC-NCDR Auxiliary Shockwave Intravascular Lithotripsy (IVL) Dataset v1.0:

  • Complimentary update – no annual or set up fees.
  • Shared Data Entry Tool with the ACC-NCDR CathPCI registry.
  • Shared reporting with ACC-NCDR CathPCI registry including an interactive user-friendly query tool.
  • Integration across all heartbase registries including ACC-NCDR, STS, & GWTG.
  • Optional interoperability with the EHR and other hospital systems.

If you’re an ACC-NCDR CathPCI data manager or abstractor and have any questions, please contact heartbase trainer Carmen Ernst for more information.

About heartbase, Inc. For 30 years, heartbase has provided inventive cardiac database and reporting solutions to hospitals across the United States through a dedication to clinician-focused design and client-centered collegial partnerships. Through this commitment, heartbase has pioneered the most innovative and clinically intuitive tools for standardized & custom registries (STS, ACC-NCDR, GWTG, CMS, ELSO, State, & Custom datasets), advanced analytics (interactive dashboards & ad-hoc querying), system interoperability (EHR & other hospital system interfacing), and financial & coding reconciliation (toolkits to identify areas for increased reimbursement).

Happy Holidays from heartbase

Wishing you and your family a safe and Happy Hanukkah, Merry Christmas, Joyous Kwanzaa, and Happy New Year!

Thank you for being a part of the heartbase family!

Warmest Wishes,

The heartbase Team

Heartbase, Inc. Certified in STS General Thoracic Surgery Database v5.21.1


CHICAGO, IL – We are excited to announce that heartbase is now officially certified by the Society of Thoracic Surgeons to accept and submit data for the newest version of the General Thoracic Surgery Database (GTSD) Registry. Version 5.21.1 will go live beginning with July 1st surgeries, and our customers will be given the opportunity to begin working with the new version upon installation.

The changes to the new registry version do not end with the name. A few notable changes that users should expect in STS GTSD v5.21.1 include:

  • One DCF for all Procedures.
  • Collection of ECOG only on analyzed cases.
  • Procedure weighting with the highest weight assigned Primary Procedure. Secondary Diagnosis is no longer collected.
  • 92 New Fields; 169 Deleted Fields; and 30 Definition Changes.
  • Updated Data Specifications and Data Dictionary.
  • All NQF Measures have been retired.
  • Optional Customization: Sites can retain both the secondary diagnoses and NQF measures. Please contact heartbase support if you’re interested in this customization.

To better prepare our customers for the changes to the GTSD Registry, heartbase clinical specialist Carmen Ernst will hold a special training class on June 29th at 1 pm CT outlining updates to v5.21.1 along with a review of the updated heartbase web-form and number DCF. Heartbase customers can click here to register for this class.

If you’re an GTSD data manager or abstracter and would like to take a look at our new forms, please contact heartbase sales associate Alex Potanos to schedule a review session.

About heartbase, Inc. Since 1992, heartbase™ has provided health care centers with the most technologically innovative and clinically intuitive data management and analytic solution in the industry. Working collegially with its immense network of users, heartbase™ has created a vast library of reporting tools that provides its clients with complete control of their hospital-owned clinical data. Heartbase’s revolutionary hbCOR platform propels clinical performance, aligns clinical data with registry requirements, and unites health care systems from across our network to the most comprehensive reporting repository in the industry.

Heartbase, Inc. Now Supports the ACC-NCDR CathPCI Risk-Adjusted Measures

Standardized Bleeding & Risk Adjusted Bleeding, In-Hospital Risk Adjusted Mortality & 30-Day Risk Adjusted Mortality, and Risk Adjusted Acute Kidney Injury & Risk Adjusted Dialysis

CHICAGO, IL – Heartbase now officially licenses the ACC-NCDR CathPCI Adjusted Measures for CathPCI: Standardized Bleeding & Risk Adjusted Bleeding, In-Hospital Risk Adjusted Mortality & 30-Day Risk Adjusted Mortality, and Risk Adjusted Acute Kidney Injury & Risk Adjusted Dialysis. This update will be available in both the standard hbReporting and hbAnalytics platforms.

Highlights of heartbase’s support of the CathPCI Risk-Adjusted Measures include:

  • Network, Hospital, Provider, and Patient-Level Drill-through with real-time analysis of outliers.
  • Integration of the risk-adjusted measures into the Executive Summary reports – with additional breakout dashboards.
  • Optional financial integration with the heartbase Financial Module.

If you’re an ACC-NCDR CathPCI data manager or abstracter and have any questions, please contact heartbase Account Manager Alex Potanos (apotanos@heartbase.net) for more information.

About heartbase, Inc. Since 1992, heartbase™ has provided health care centers with the most technologically innovative and clinically intuitive data management and analytic solution in the industry. Working collegially with its immense network of users, heartbase™ has created a vast library of reporting tools that provides its clients with complete control of their hospital-owned clinical data. Heartbase’s revolutionary hbCOR platform propels clinical performance, aligns clinical data with registry requirements, and unites health care systems from across our network to the most comprehensive reporting repository in the industry.

Heartbase, Inc. Certified in ACC-NCDR ICD/EP Device Registry Database v2.3


March 26th 2021

CHICAGO, IL – We are excited to announce that heartbase is now officially certified by the ACC-NCDR to accept data for the newest version of the ICD/EP Device Registry Database. Version 2.3 will go live beginning with April 1st, 2021 discharges. As one of the first vendors to be certified, we will work diligently to provide our users with the service and support they need as they begin abstraction in this new version.

While this change is relatively minor in scope, a few notable changes that users should expect in ACC-NCDR ICD/EP Device Registry Database v2.3 include:

  • Capture of shared decision making, part of the NCD.
  • Capture of novel pacemaker procedures with a focus on CRT-p, His bundle, and leadless pacing.

On April 7th at 12 pm CT, heartbase clinical specialist Carmen Ernst will hold a special training class covering the ins-and-outs of this version change. Heartbase customers can click here to register.

If you’re an ICD data manager or abstractor and would like to take a look at our new forms, please contact heartbase sales associate Alex Potanos to schedule a review session.


About heartbase, Inc.

Since 1992, heartbase™ has provided health care centers with the most technologically innovative and clinically intuitive data management and analytic solution in the industry. Working collegially with its immense network of users, heartbase™ has created a vast library of reporting tools that provides its clients with complete control of their hospital-owned clinical data. Heartbase’s revolutionary hbCOR platform propels clinical performance, aligns clinical data with registry requirements, and unites health care systems from across our network to the most comprehensive reporting repository in the industry

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