Errors while coding in radiology environment can be expensive in the long run, given the denial rates. In order to get as near to perfection, certain basic knowledge when coding and billing in radiology is essential.
- Checking for pre-authorization for procedures such as MRI, CT, and ultrasound. Insurance verification is a must
- Make sure that that your report is as explicit and specific as possible, like anatomic sites, etiology and severity, as coders can sniff out a fraud
- Ensure technologists capture patients signs and symptoms and are included in their notes in the RIS/PACS system so that you as the radiologist reference it in your report
- Radiologists should not forget about even the smaller collection on each CPT code. Even the minimally reimbursed codes while using procedures like single view and two view x-rays can well add to the revenue cycles in the long run
- The constantly updated CPT handbook is very essential for every radiologist as coding of any new imaging technique requires the provision of one or more procedural(CPT) codes and one or more diagnostic codes, now a necessary prerequisite to their being covered in reimbursement systems
- Every radiologist should be aware of modifiers and thus help reduce the risk of denials and thus improve audit compliance. Incorrect usage of modifiers in the radiology practice is stated to be the second most reason for reimbursement being lost. The most common modifiers in radiology billing are 26, TC, 76, 77, 50, LT, RT, and 59. The most crucial modifier, no 59, has often been misused. It is basically employed only if no other descriptive modifier is available
- With the standard processes conducted include Recovery Audit Contractors (RACs) and Comprehensive Error Rate Testing (CERTs), radiologists now need to be aware of the terminologies when exams are being performed.
- Templates employed by radiologists need to be reviewed and updated regularly, especially when change in equipment, techniques and/or protocols occur.
- Detailed Documentation is a must by radiologists. ICD-10-PCS codes have three sections devoted to radiology, used for inpatient procedures, so coding of dictation will depend on if patient was in/or outpatient. Often report codes may differ because the patient can be examined twice.ICD-10-PCS codes for inpatients must be matched correctly with the CPT code for the procedure. If appropriate codes and detailed reporting, such as matching up codes for the diagnosis in the ICD-10-CM code list are in error, reimbursement may be delayed and revenue lost
Thus it is vital to know your radiology billing and coding in depth, so as to avoid errors causing revenue loss.