Work

The Role of Coding Accuracy in Enhancing TAVR Risk Adjustment

Year: 2025

Type: article

Abstract: BACKGROUND: The low rate of appropriate comorbidity documentation in transcatheter aortic valve replacement patients leads to incorrect Medicare Severity Diagnosis Related Group coding resulting in a skewed risk assessment and revenue loss. PROJECT RATIONALE: Improving capture of a specific comorbidity, heart failure, could result in improved perioperative risk assessment and improve revenue generated. PROJECT SUMMARY: A multidisciplinary team implemented a standardized form, tracking processes using a third-party registry vendor tool (hbCOR and hbRecon), and weekly/monthly reviews. This intervention significantly increased the accurate capture of heart failure and Medicare Severity Diagnosis Related Group 266 coding, resulting in an estimated $414K revenue increase over 6-month time frame and improved preprocedural risk evaluation, demonstrating that simple coding and documentation practices can substantially enhance both financial and clinical outcomes. TAKE-HOME MESSAGE: A simple standardized form can improve comorbidity capture, leading to better perioperative risk evaluation and greater revenue generation.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.105766

Authors: Omar Rizvi, Rachel M. Bond, Kerry A. Webb, Angelina R.R. Erwin, Jessica Parsons, Dan Inder S. Sraow

Institution: University of Arizona

Language: English

Topic: Medical Coding and Health Information

Subfield: Health Information Management

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850