What Are The Radiology Billing Guidelines & Why Do You Need To Follow Them?

Touseef Riaz

February 13, 2023

Radiology Billing Guidelines

What is Radiology?

Medical Imaging is a medical profession used to diagnose and treat patients. Radiology is a subspecialty of medicine, and it’s considered a branch of medicine. The word “radiology” comes from the Greek roots meaning “ray” or “ray-like formation.” It refers to X-rays that produce images by passing through tissue.

What are the Radiology Billing Guidelines and why do you need to follow them

The radiology field is one of the most exciting in medicine, and it’s also one of the trickier fields to navigate. There are many different types of radiologic procedures, each with its coding guidelines. In this guide, we’ll walk through how you use radiology billing guidelines when you have to report radiology services so that you can charge accurate bills from your clients for their care. We’ll also discuss other elements affecting your choice of MRI coding codes. It includes procedures (such as technical component fees, surgical fees, and geographic region).

Reporting radiology services requires a standard set of documentation. This is done to ensure the proper steps were taken to record the patient’s condition at discharge.

Why do Radiologists follow Radiology Billing Guidelines?

It would help if you had a grasp of the basics of radiology billing guidelines and the details.

  • These guidelines ensure that your reports are submitted correctly and accurately.
  • These rules help you to avoid problems with insurance companies and other healthcare professionals. These companies and professionals may be reviewing your work product.

Why is Radiology an Essential Part of the Health Care System?

Radiology is a branch of medicine that deals with images. These images are taken from inside patients’ bodies. This can be done using x-rays, CT scans (or sometimes ultrasound). MRI scans (magnetic resonance imaging) and ultrasounds can also be used for this purpose.

Radiologists are doctors who diagnose diseases. They can do it by looking at the human body parts with MRI machines, diagnostic CT scan machines, and many more. They can also do it by using other imaging techniques. These techniques include ultrasound machines that send high-frequency sound waves into the tissue. This will create images on glass plates. These images will show the pathology in the observed human body part.

How have Radiology Services Affected the Health Care System?

Radiology services are an essential part of the health care system. They help to diagnose and treat diseases. They also help to detect problems early on and plan treatment. Later, they can track the progress of a disease, provide better care, and more.

Who are Radiologists?

Radiology is the study of body structures and functions using imaging technology. Radiologists specialize in medical imaging to diagnose and diagnose various conditions. These conditions are cancer, heart disease, and stroke. They are also known as diagnostic radiologists or imaging specialists.

Without Radiology Billing Guidelines, you are Going to Lose Money.

Medical billing is the most crucial aspect of your radiology practice. Without it, you are going to lose money. As a radiologist with a small practice, outsourcing the medical biller can help you minimize expenses and maintain profitability in your business.
Outsourcing radiology billing provides several benefits for both parties:

  • The radiologist gets more time with patients so that they can provide better care overall.
  • The patient has fewer questions about their bills because they’re easier to understand.

What is Medical Coding?

Medical coding is assigning codes to medical procedures and diagnoses. It also gives codes to other healthcare services provided to patients. Coding helps healthcare providers and payers track. It also helps to report the healthcare services that patients receive. It also allows them to bill insurers for these bills.

Medical coders use various tools when coding information about a patient’s visit. These tools also include computerized systems.

The patients get medical codes when they visit their healthcare provider for an illness. The visit can be with their doctor or nurse practitioner (NP). For example, the NPS has electronic medical records containing all the information they need when they meet with their patient in person. The document includes namely: date; time; type of visit; type of service requested; etc. The medical record also consists of other relevant details such as allergies or previous treatments received by the patient during visits with different providers over periods ranging from 6 months to today’s date minus ten years ago.

What is Medical Billing?

Medical billing is submitting a claim to an insurance company for payment. Your patient’s primary care physician or a third-party vendor can do this. Even the radiology department at your hospital can do it. Medical bills are submitted through two main channels. These channels are Medicare and commercial insurers (including HMOs). In cases with no insurance coverage or reimbursement available. You must submit the bill directly to the patient’s doctor. This can be achieved by using the addresses listed on file for billing purposes.

CMS Ultrasound Guidelines

The CMS ultrasound guidelines are a set of definitions, standards, and recommendations. They are used for coding and reporting services in the radiology setting. This document includes all services performed at sites where an IC (Imaging Center) or IMA (Imaging Medical Agency) takes part in the payment process.

The CMS ultrasound guidelines define specific procedures that may be considered diagnostic. They may also be regarded as therapeutic if they meet specific criteria.

What are Radiology Documentation Requirements?

When you use a code from any subcategory, be assured the scope of the code covers all the services performed during a single session. To illustrate this point, we’ll use an example that uses principles. These principles are from Subcategory 4 (radiographic procedures) and Subcategory 5 (diagnostic procedures).

In this case, if you were coding for a patient, many radiologists had seen within one day. You would need to assign both MRIs and CT scans to all those patients who were receiving MRIs. These procedures would be given to capturing all images performed on them, besides this rule in our documentation standards manual. Many other organizations’ guidelines also cite it. It also includes those from our organization. It’s also easy enough for us at Coding Standards Development Committee meetings. When we discuss changes made during implementation like ours now: “We’re working on it!”

CPT Codes for Radiology 2022

The Radiology coding cheat sheet provides complete detail of CPT radiological codes. The following codes are used to report radiology services:

  • 74185 MRA ABDOMEN 
  • 74181 MRI ABDOMEN w/ contrast 
  • 74182 MRI ABDOMEN w/ contrast 
  • 74183 MRI ABDOMEN w/ & w/o contrast 
  • 70551 MRI BRAIN w/o contrast 70552 
  • MRI BRAIN w/ contrast 70553 MRI BRAIN w/ & w/o contrast
  • 77047 MR BREAST BILATERAL without contrast (IMPLANTS)
  •  77046 MR BREAST (Left or Right) w/o contrast 
  • 77048 MR BREAST (Left or Right) w/ & w/o contrast
  • 77021 MR BREAST LOCALIZATION (https://www.mainstreetradiology.com/media/1388/msr_cpt-code_list_2020-2.pdf).

ICD-10 Radiology Coding Guidelines

ICD-10 radiology coding guidelines provide sets of rules and regulations to radiologists. It helps the radiologists report their services. When you’re coding, following these guidelines is essential. So your codes will be accepted by insurance companies and paid out correctly. Three types of procedures can be reported using ICD-10. These are single policies, many practices, or procedures performed on various patients. 

Importance of Practicing Radiology Guidelines

When determining which code(s) to use for radiology services. You should use your best clinical judgment. But, referring to the CPT radiology billing guidelines when needed can be helpful. Other factors that may affect coding decisions include:

  • Technical component fees (if applicable).

Extra charges are not included in the base fee. It may consist of anesthesia, equipment rental or use, instrument repair, and maintenance costs. This can be very confusing for your patients. They only know how much their insurance company will pay them. They will get paid after receiving their bill from us (usually not until months later).

We recommend using these codes instead of using an unrelated medical code. Code, like “C10-D03,” because these costs won’t appear on your patient’s bill. But it will be deducted from any leftover funds you have left over after paying out all other bills. For example, these bills might be related to a service rendered by our hospital during the same day(s) and month(s).

A good example would be if someone needed an operation on their spine but didn’t want anesthesia. We’d use C10-D19 because there wasn’t any extra charge for sedation instead of general anesthesia. Because this surgery requires less time spent waiting around while recovering afterward.”

  • Oncology Reporting:

When you report oncologic imaging studies such as breast MRIs and CT scans, you should remember that all patients have at least one abnormal finding on the initial CT scan. Thus, we need to report all conclusions on the basis of radiology billing guidelines. Even if they are not significant (i.e., 0% probability).

  • Geography:

The geographic region where the procedure was performed.

For example, if a patient had a CT scan in Canada but had it performed by an American radiologist. That radiologist charged $500/hour while traveling back home from New York City. They were traveling during their vacation trip last month. Then this would cause a different set of guidelines. But, If someone had an MRI done in the same city but by someone else. 

Benefits Outsourcing Radiology Billing

You will:

  • Save time by outsourcing all of the billing for you!
  • Please focus on the day-to-day operations of your practice so that when it comes time for an appointment or procedure (or hospital visit), there will be no confusion about who should be billed or how much should be billed.*
  • The status of each claim.
  • Reimbursements made by insurance companies or other payers.
  • Payments made by patients (such as deductible amounts) can focus on your patients, practice, business, and family.
  • You can focus on your patients, practice, business, and family.
  • You can track the progress of your medical billing and see the status of your claims, payments, and reimbursements.

Why Should you use Software for Medical Billing?

When you use software for medical billing, it will help you to save time and money. You should consider using this kind of software if you want to:

  • Save time by reducing the number of calls that need to be made.
  • It helps to save money by reducing the cost of paper-based invoices and faxes.
  • Reduce stress by ensuring all staff members are working together on one platform instead of having multiple email inboxes or spreadsheets with different patient information in each one (which can lead to errors).

How to Choose the Right Radiology Billing Company?

When choosing a radiology billing company, finding one with a good reputation is essential. For example, suppose a hacker gets into your system and steals private data. Therefore, it could be used by others in harmful ways for you or others involved with the business.

Before choosing them, consider how much they charge per month and whether they offer discounts or coupons on top of their prices if possible (this will save money in the long run). You may even ask around amongst friends who have worked with different companies. It will help you to get ideas about which ones offer better services. 


Medical billing for radiology is simple and exciting. The radiology billing guidelines are an excellent place to start your practice. It would help if you always used your clinical judgment when coding for radiology procedures. Remember that these guidelines do not cover every circumstance. Moreover, other factors influence coding decisions. If in doubt, call the hospital billing department to know about the code. You can also talk to the physician about which code should use for particular services.

You need a billing partner like U Control Billing to focus more on your patients. Our experienced professionals will help you with your medical billing. We aim to ensure that you understand how much money is coming in and where it goes so that we can save time and money for both parties involved in the transaction. The three most important things we offer are accuracy, affordability, and excellence.


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