Radiology Billing and Coding Essentials : Mastering the Basics

Radiologists often find fulfillment in their work but tend to view the back-end tasks of billing and reimbursements as laborious and burdensome. Some healthcare providers and radiologists attempt to manage medical billing and coding themselves, which can result in significant expenses and efforts spent on employee training, staying updated with compliance changes, and competing with similar healthcare facilities.

Experts suggest that for every 1,000 procedures conducted, radiologists need to accurately identify over 1,000 Current Procedural Terminology (CPT) codes and apply an equal number of ICD-10 diagnosis codes. These complexities further contribute to the challenges associated with radiology billing and coding. Moreover, there are numerous other factors and compliance requirements that must be considered during the processing of radiology bills.

Radiology coding encompasses various components, such as X-Ray, Fluoroscopy, Computed Tomography, Magnetic Resonance Imaging, and Nuclear Medicine. Each of these areas requires specific coding expertise and attention to detail to ensure accurate billing and reimbursement processes.

Commonly used Radiology Procedures Codes

70010-76499 Diagnostic Radiology (Diagnostic Imaging) Procedures

76506-76999 Diagnostic Ultrasound Procedures

77001-77022 Radiologic Guidance

77046-77067 Breast, Mammography

77071-77092 Bone/Joint Studies

77261-77799 Radiation Oncology Treatment

78012-79999 Nuclear Medicine Procedures

Challenges in Radiology Billing and Coding:

  • Incomplete documentation: This can lead to delays in payment or denial of claims because the insurance company will need more information to approve the claim. For example, if the documentation does not include the patient’s diagnosis, the insurance company may not be able to determine if the radiology services were medically necessary.
  • Coding errors: This can also lead to delays in payment or denial of claims. Coding errors can occur when the wrong codes are used, or when the codes are not used correctly. For example, if the wrong code is used for a particular procedure, the insurance company may not pay the claim.
  • Complex coding: Radiology coding is complex because there are many different codes that can be used for different procedures. It can be easy to make mistakes when coding radiology services, especially if the person doing the coding is not familiar with the latest coding guidelines.
  • Time-consuming: Radiology billing can be time-consuming because there are a lot of steps involved in the process. For example, the documentation must be reviewed, the codes must be assigned, and the claims must be submitted to the insurance companies.
  • Compliance requirements: There are a few compliance requirements that must be met when billing for radiology services. These requirements are designed to ensure that the billing is accurate and that the patients are protected. For example, the billing must be compliant with the Health Insurance Portability and Accountability Act (HIPAA).

To address these pain points, it is important to have a clear understanding of the coding requirements and to have a system in place for ensuring that documentation is complete and accurate. It is also important to have a team of experienced professionals who can handle the complex coding and compliance requirements.

Tips for accurate accountability of radiology procedures by AAPC:

  1. The American College of Radiology (ACR) guidelines recommend that diagnostic imaging reports should include the patient’s demographics, relevant clinical information, the body of the report (findings), an impression (conclusion or diagnosis), physician signature, and diagnostic studies (plain films). The reports should be written in a clear and concise manner, using language that is understandable to both radiologists and referring physicians. The reports should also be timely, with a turnaround time of no more than 24 hours for most studies.
  2. Radiology procedures typically have two components: technical and professional. The technical component includes the equipment, supplies, and personnel used to perform the exam, while the professional component includes the physician’s work in providing a dictated report or dictated report and supervision. Modifier TC is used to report the technical component of a service, and modifier 26 is used to report the professional component of a service. Global services occur when the physician bears the expense of equipment, supplies, etc., and provides supervision and/or prepares the report. In this case, modifiers TC and 26 are not required.

For example, if the radiologist reads a two-view chest X-ray in the hospital, you will report 71046 Radiologic examinations: chest, 2 views with modifier 26. If the equipment with which the X-ray is performed is from the radiologist’s office then you would report 71046 without a modifier.

  1. The number of views that are reported for a radiology exam must be based on the documentation in the medical report. The coder cannot use a department or office standard for the number of views, as this may not be accurate. The coder must count the number of views that are actually performed and select the corresponding CPT code.
  1. It is important to remember the inclusion of supplies when it comes to diagnostic nuclear medicine studies and PET (Positron Emission Tomography). It’s crucial to note that radiopharmaceuticals are not automatically included in these procedures. Therefore, hospitals and privately owned nuclear medicine and PET departments/offices need to report the radiopharmaceutical kit separately using the appropriate supply code(s). This ensures accurate documentation and billing, allowing healthcare facilities to appropriately account for the costs associated with these essential supplies. By diligently reporting the radiopharmaceutical kit separately, healthcare providers can ensure transparency in their billing processes and maintain compliance with radiology coding and reimbursement guidelines.

Here are some additional tips for avoiding pain points in radiology billing:

  • Use a qualified coding specialist to ensure that your claims are coded correctly. A qualified coding specialist will have the knowledge and experience to correctly assign the codes for your radiology services.
  • Keep good documentation of all radiology services provided. This documentation should include the patient’s diagnosis, the procedures that were performed, and the results of the procedures.
  • Stay up to date on the latest coding and compliance requirements. The coding and compliance requirements for radiology billing are constantly changing. It is important to stay up to date on these changes so that you can ensure that your billing is accurate and compliant.
  • Use billing software that can help you automate the billing process. Billing software can help you to automate the billing process, which can save you time and reduce the risk of errors.

Given the intricacies involved in radiology billing and coding, many healthcare providers and radiologists opt for professional assistance to streamline their revenue cycle management. By partnering with QWay Healthcare you can alleviate the administrative burden, enhance compliance adherence, and improve their financial efficiency, allowing you to focus on their core expertise—providing exceptional diagnostic services to patients.

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