Radiologists perform both interventional and non-invasive / non-invasive procedures. Interventional radiological procedures include diagnostic radiological imaging and ultrasound, while non-interval procedures include standard radiographs, single or multiple types, contrast studies, computed tomography and magnetic resonance imaging.
In order to receive proper compensation for the procedures performed, radiologists must perform proper disease coding and diagnosis or ICD-9 coding (using three-digit codes, which are modified by including the fourth or fifth digit as the characters after the decimal point) and procedural using current procedural terminology (CPT ) containing 5 digits with 2-digit modifiers. This procedure will only be considered a medical necessity with an ICD-9 supporting diagnostic code. Occasionally, multiple codes, such as radiological and surgical codes, may be required to report a complete procedure. Cardiac medical visitors must be filled with radiological CPT codes that are associated with other CPT codes. When billing for radiological services, recoding & # 39; (coding a higher or more complex level of service than what was actually performed) should be strictly avoided, as this is considered fraud or abuse. Another important factor is to ensure that services require prior authorization for proper reimbursement by the carrier.
Radiological codes
Radiological codes combine 70,000 series of codes organized by the method or type of radiology and the purpose of the service. They are subdivided based on the type of service and the anatomical site.
These include:
• Diagnostic Radiology 70000 - 76499
• Diagnostic Ultrasound 76500 - 76999
• Radiological Guide 77001 - 77032
• Breast, mammography 77051 - 77059
• Bone / joint research 77071 - 77084
Radiation Oncology 77261 - 77999
• Nuclear medicine 78000 - 79999
Interventional radiologists use specific surgical codes to refer to procedures that are performed. Some major surgical codes include the following:
• Mechanical thrombectomy: 34201, 34421, 34490
• Biliary drainage: 47510, 47511, 47530
• Cholecystostomy tube. Accommodation: 47490
• IVC Filter Placment: 37620
• Gallstone removal: 47630
HCPCS codes
Health services and materials not included in CPT coding terminology are listed in the health system coding procedure code (HCPPs). They are represented by 1 letter (from A to V), followed by four digits. To refine the procedure, you can use numeric or alphanumeric modifiers along with these codes.
Billing for radiological services
The radiological service may be paid for the work of the doctor, as well as for the use of equipment or consumables. The technical component (CU) includes facilities, equipment, materials, services before and after the injection, personnel, etc. The professional component (PC) includes studying and conducting an interview about the radiological test and presenting a written report with the results. Modifiers are used to refer to technical and professional components in a radiological service. These are 2-digit numbers that are used to explain the procedure in more detail. They may indicate repeated or multiple procedures, such as radiographs, performed bilaterally. When billing only for the technical component, you must use the modifier 52; when billing only for the professional component, it is necessary to use the modifier 26. In the latter case, a written report from the physician providing the services is required to prevent a denial of claim.
Some other examples of modifiers:
• -22 - unusual (increased) procedural maintenance
• -32 - mandatory services
• 51 - several procedures
• -66 - surgical team
• -76 - repeat the procedure at the same doctor
• -77 - repeat the procedure by another doctor
• -LT, -RT, -TA to -T9, -FA -F9, -LC, -LD, -RC - anatomical modifiers
The global fee includes a total payment due for the technical and professional components, and this also requires a formal written report.
Payment for the professional component
Doctors can pay for the professional component of the radiological services provided to the individual patient in all cases, regardless of the physician’s specialty performing this service. Refunds will be provided in accordance with the doctor’s payment schedule. However, for radiological services provided to hospital patients, insurance companies reimburse the professional component only under the following conditions:
• Services must comply with the terms of the payment schedule.
• Services provided must be identifiable, direct and discrete diagnostic or therapeutic services provided to the individual patient.
Fee for the technical component
With regard to the technical component or TS of the radiology services provided to hospital patients and inpatient nurses (SNF) during their stay in Part A, insurance carriers cannot provide reimbursement. The fiscal intermediary (FI) / AB MAC pays for the administrative / supervision services provided by the doctor, as well as the services of the provider. TC radiology services offered for inpatients in hospitals, excluding CAH or Critical Access hospitals, are included in FI / AB MAC fees to hospitals. In the case of outpatient hospitals, radiology and related diagnostic services are reimbursed in accordance with the Outpatient Perspective Payment System (OPPS) to a hospital. In the case of SNF, the radiology services provided to its inpatients will be included in the advanced SNF payment system (FPS). For services offered to outpatients in SNF, billing can be done by the service provider or SNF as agreed with the provider. When billing is made by SNF, Medicare reimburses for expenses under the Medicare Medical Benefit Collection Plan.
Radiology Billing Standards
Radiological services can be paid for in several ways. Some of the services are shared with the possibility of payment, and the codes for them are separately reimbursed by various suppliers for the professional and technical component. The physician and the facility can pay for their component with modifiers 26, TC or ZS. With full billing for the payment of bills, the doctor pays for both professional and technical components and makes payment for the expense of the technical component provided. In standard billing, the bill for services is for both professional and technical components and reimburses the doctor for its professional component. Services that cannot be paid separately are not reimbursed individually for professional or technical components. These codes are reimbursed for only one provider and should not be presented with modifiers 26, TC or ZS.
Assign Codes
• Medical records are carefully studied to determine the radiological service being performed.
• Identify anatomical site
• Find terms in the CPT index
• Select codes based on radiological terminology
• See if modifiers should be assigned.
The following skills are needed for accurate coding and billing for radiological services:
• Ability to address clinical issues and recommendations CPT, ICD-9 and HCPS for interventional and non-invasive radiology
• Knowledge of the differences between diagnostic radiology codes and therapeutic intervention radiological codes
• Ability to view coding guidelines for use of the modifier using interventional radiology procedures
• Ability to code complex case scenarios
Professional coding services for accurate billing and coding
When it comes to coding, the radiologist faces two major problems: first, downplaying the completed treatment can mean insufficient recovery; secondly, if codes exaggerate treatment, it can lead to the risk of abuse, repayments and fines. Another problem is the complex and constantly changing directives regarding CPT procedures.
Radiologists can solve all these problems by entering the services of professional medical coding companies. They have experienced CPT coders to do the job. With great attention to detail, in-depth knowledge of the coding system, application of basic coding principles, and thorough documentation, these companies offer fast, personalized, and inexpensive medical care and radiology coding as soon as possible. Most professional companies use modern billing software to ensure efficiency and accuracy in billing and coding, to verify local coverage determination, etc., to ensure that all claims are reimbursed.
