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Every 40 seconds, someone suffers from a heart attack in the United States, according to the Center for Disease Control and Prevention (CDC). Cardiovascular disease is, in fact, the leading cause of death in the United States.

To diagnose heart problems, healthcare providers often use services like cardiac catheterization, as well as coronary and peripheral interventions. However, tools to accurately document, code, and bill for these services are not common.

Due to documentation, coding, and billing complexities, many cardiovascular services are misreported. Flawed reports can lead to compliance breaches, ineffective patient management, and inaccurate billing—each of which negatively impact hospital revenue. These complex reporting processes also often result in burnout among cardiologists, leading to ineffective patient care and turnover.

To combat the reporting issues in cardiovascular units, hospitals need to evaluate why it is so difficult and implement tools that eliminate errors and allow cardiologists to spend more time on patient care and less time on their computers.

The Complexities in Cardiovascular Reporting

Cardiologists face perhaps the most intensive reporting requirements of all healthcare workers. Coding for cardiac procedures are incredibly time-consuming and complicated, yet necessary to ensure compliance and accurate billing. The variations in clinical presentations, methods, communication, and documentation styles across doctors make cardiovascular coding particularly complex. Routine changes in code standards and regulations only add to the complexities.

The Widespread Impact of Complex Coding Challenges

The complexity of cardiovascular coding often results in errors, such as over-coding (adding more codes than necessary in the report) or under-coding (not providing efficient coding to represent the procedure). ZHealth, the leading authority on interventional cardiology coding, found that approximately 45 percent of cardiovascular reports contain coding errors. About 1 in 6 cases pose a compliance risk from over-coding, and nearly $8,000 per under-coded case in Medicare reimbursement is lost.

Detailed documentation also contributes to physician burnout. More than one out of every three heart doctors in the U.S. report feeling burned out, according to the American College of Cardiology (ACC). Of those who reported feeling burnt out and stressed were, in fact, more likely to also report that they had insufficient time for documentation and felt a lack of control over their workload.

The COVID-19 pandemic has only made matters worse. Patients with heart disease are more susceptible to the virus and COVID-19 can cause cardiovascular disorders. As a result, already burnt-out cardiologists are faced with more patients—and therefore more documentation and coding.

Computer-Assisted Physician Documentation (CAPD) Solutions Can Help

CAPD solutions are designed to automatically improve the efficiency and quality of complex reporting. Cardiac-specific CAPD solutions allow cardiologists to build complete, accurate documentation in real-time that properly bills the procedure through the automation of coding.

For example, Nuance Cardiovascular CAPD, developed in partnership with ZHealth, combines the use of anatomical images with a single-documentation coding engine to automate the reporting process. The technology allows cardiologists to quickly capture pathology and procedure details in a graphic, then the engine transforms the case description into codes, which are kept current with the latest guidelines.

The Nuance Cardiovascular CAPD solution can eliminate coding errors and allow cardiologists to spend more time dedicated to caring for their patients and less time on their computers. Cardiologists have already been able to decrease time spent on documentation, coding, and billing processes by using CAPD solutions. Healthcare systems have been able to bill patients more quickly and ensure near-100% accuracy with their cardiologists’ documentation.

There’s a spotlight on heart disease that doesn’t seem to be dimming, and cardiac units must be prepared to continue combatting this disease.


Michael Clark ( is senior vice president and general manager for provider solutions, Health Division, at Nuance Communications, Inc. (NASDAQ: NUAN), a technology pioneer with market leadership in conversational AI and ambient intelligence. A full-service partner trusted by 90 percent of US hospitals and 85 percent of the Fortune 100 across the globe, Nuance creates intuitive solutions that amplify people’s ability to help others.


Nuance healthcare solutions capture, improve, and communicate over 300 million patient stories each year, helping more than 550,000 clinicians at 10,000 healthcare organizations worldwide drive meaningful clinical and financial outcomes. Delivering a more complete and accurate view of patient care, Nuance’s ambient clinical intelligence, clinical speech recognition, CAPD, CDI, coding, quality, and radiology solutions provide a more intelligent approach to clinical documentation—freeing clinicians to spend more time caring for patients.

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