The Role of Coding Accuracy in Enhancing TAVR Risk Adjustment: Findings From a Pilot Study

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.

Improving capture of a specific comorbidity, heart failure, could result in improved perioperative risk assessment and improve revenue generated.

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.

A simple standardized form can improve comorbidity capture, leading to better perioperative risk evaluation and greater revenue generation.