Radiology is a specialized medical specialty in which medical practitioners don't always see the patient. Like any other medical doctor, radiologist conducts physical exams and performs face-to-face consultations, but their professional skill lies in using sophisticated imaging technology to diagnosis disease. Radiology medical billing is different from rest of medical billing.
A radiologist will examine the patient, which is usually by referral from another M.D. (specialized doctor). After determining that a radiological exam is warranted, the patient will undergoes certain procedure. The results are then conveyed by the radiologist in order to render a report of the findings and a diagnosis. Interventional radiology adds another wrinkle to the services offered by radiology practice. Invasive medical procedures can be performed under radiological guidance. Hence there are specific medical biller and coders for that, and accurate radiology coding is the strength of radiology billing.
The technical component of a radiology code is reported on a healthcare claim when the procedure is performed but it is not interpreted by a staff radiologist. Common Procedure Terminology (CPT) codes used for radiology billing assume that the rendering physician performs or oversees a procedure and provides medically useful information based on the results. A radiology practice cannot bill for an interpretation of a test's results if a professional diagnosis has not been rendered. This is why radiology CPT codes are split into two parts - technical and professional components.
A certified radiology technician, preps the patient, performs the exam, and generates a report. If that report is sent directly to the ordering physician without radiologist review, there is no professional component for the service. Medically necessary services have been supplied by the radiology practice, but it cannot bill for what it did not do.
Through the use of appropriate modifiers, professional and certified radiology medical billers and coders can recoup appropriate reimbursement for these services. The payment is not as high as that for the service with professional interpretation, but it covers the cost of providing the service with room for profit.
If a radiologist is sent test results that have not yet been reviewed by a fellow physician, he or she cannot bill for the entire procedure, but the professional component should be billed. By modifying applicable CPT codes, radiology billers can capture legal reimbursement for the physician work needed to establish a diagnosis and contribute to the patient's treatment plan.
Professional medical coders and billers are expert in the use of modifiers used according to individual payer guidelines. They can perform pre-payment internal audits to ensure that clean claims are submitted for payment. To get proper reimbursement for the procedures they perform, radiologists need to execute proper disease and diagnosis coding or ICD-9 coding using 3-digit codes that are modified by including a fourth or fifth digit as characters following a decimal point), and procedural coding using Current Procedural Terminology (CPT), comprising 5 digits with 2-digit modifiers.
The procedure will be considered medically necessary only with a supporting ICD-9 diagnostic code. Sometimes multiple codes, such as radiological and surgical codes may become necessary to report a full procedure. The medical billers have to be thorough with radiology CPT codes that are bundled with other CPT codes. Another important factor is to ensure whether the services require prior authorization to be properly reimbursed by the carrier.
• Ability to review clinical issues and CPT, ICD-9 and HCPCS coding guidelines for interventional and non-interventional radiology
• Knowledge about the differences between diagnostic radiology codes and therapeutic interventional radiology codes
• Skill to review coding guidance for modifier usage with interventional radiology procedures
• Ability to code challenging case scenarios
When it comes to coding, the radiologist faces two main issues: first, understatement of completed treatment could mean insufficient reimbursement; second, if the codes overstate the treatment, it could result in risk of abuse, repayments and fines.
Radiologists can resolve all these issues by going in for the services of professional medical coding companies. They have skilled 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 professional medical billers and coder companies offer accurate, customized and affordable radiology medical billing and coding services in quick turnaround time. Most of the professional companies utilize state-of-the-art billing software to guarantee efficiency and accuracy in billing and coding, for checking local coverage determination and so on to ensure that all claims are reimbursed.
Radiology medical billers are familiar with all the aspects of radiology coding. They understand when component services need to be bundled into a more extensive procedure, and they understand when services can be billed during the same encounter, and how to modify the codes to receive appropriate payment.