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:
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.
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.
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.
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.