Radiology Medical Billing Process and Codes
The professional radiology medical billing services involves the filing diagnostic analysis and results presented by the radiologist. The professional services must be billed under the professional component of radiology medical billing. In contrast, technical services involve the radiologist utilizing equipment for imaging. These services should be coded under the technical component.
Codes for radiology medical billing come across constant changes, and the challenge is to be up-to-date about the changes. Using the wrong code results in claim denials; this makes the medical billing and coding for radiology services even more challenging. Coding for radiology includes several services, for instance:
– Diagnostic Radiology (X-Ray)
– Computed Tomography (CT)
– Magnetic Resonance Imaging (MRI)
– Nuclear Medicine (NM)
– Positron Emission Tomography (PET)
Healthcare practices for radiology medical billing face several challenges:
Medical Coding for Radiology:
CPT Code range for radiology procedures ranges from 70010- 79999. This medical code set is maintained by American Medical Association (AMA).
Following is the further categorization of Radiology procedure codes (CPT):
Diagnostic Radiology (Diagnostic Imaging) Procedures
Diagnostic Ultrasound Procedures
Radiation Oncology Treatment
Nuclear Medicine Procedures
What are CPT Codes?
CPT stands for Current Procedural Terminology codes. It is a five-digit code, maintained by the American Medical Association (AMA). Each and every CPT code is assigned to a specific procedure or service provided by a healthcare practice.
CPT codes are divided into several categories, including:
– Category I:
Category I of the CPT codes comprises the medical procedures and services codes used by the healthcare providers. These codes are five-digit numeric codes only. Category I codes are the most widely used codes by medical coders.
– Category II:
Category II of the CPT codes includes performance measurement and quality of care codes. This category of codes are alphanumeric codes, and using them isn’t a compulsion for correct coding.
Category II codes comprise five-alphanumeric characters. For instance, (0001F–0015F) codes are for Composite Measures. The four digits are followed by an alphabet, i.e., F.
– Category III:
Category III codes are also alphanumeric codes but comprise codes for emerging technology or experimental procedures and services. This category is a set of “temporary codes” allowing data collection of the new technology.
Category III codes have an alpha character in the string, i.e., the four-digit code is followed with the alphabet T.
Challenges Faced in Radiology Medical Billing:
This specialty of medicine faces a number of challenges. Some of the most common challenges are listed below:
– Administrative responsibilities:
Handling radiological examinations along with handling the administrative tasks of medical billing can be quite overwhelming. Quality patient care might be compromised in the hassle of doing everything as physicians have less time to focus on that.
For a healthcare practice, medical billing and coding are crucial parts. They play a vital role in cash flows and revenue cycle management. Medical billing and coding for radiology require experience and expertise in order to do it the right way.
– Medical claim denials and follow-ups:
A significant amount of revenue gets lost due to claim denials. Medical coding requires special attention, using the right codes, and being up-to-date about the changes in regulations. It also includes knowing about insurance payer’s guidelines and reviewing everything in detail before submitting a claim. Error-free claim results in an increased clean claim rate.
The challenge is streamlining the medical claim preparation to the submission process. All of this so that the reimbursement rate can be improved.
– Errors in medical coding:
For an in-house medical billing team, having experience and expertise is a necessity. Unqualified billing staff means increased errors and a low reimbursement rate. They might also not be up-to-date about changes in regulations and therefore affect the healthcare practice.
In order to ensure reimbursement against the procedure performed, radiologists should also make sure whether the patient is covered or not.
– Sloppy documentation:
For radiology medical billing, correct and complete documentation is essential. Incorporating the diagnostic test name, the purpose of the test, its description, findings, and the radiologist’s professional remarks should be documented. Along with these, complete diagnostic procedures must also be documented as incomplete documentation might result in claim denials.
– The incorrect number of views:
In a radiological knee exam, anteroposterior, lateral, and both obliques views should be coded. However, many medical coders tend to code this as a three-view study. Whereas it should be a four-view study given that both left and right oblique views should be there. This missed number of views is another challenge faced by radiology medical billing.
Tips for Radiology Medical Coding Services:
Error in medical billing and coding results in possible audits and claim denials or rejections. Figuring out where the healthcare practice is losing its revenues can be complicated. This is why submitting error-free medical claims for any medical center radiology billing, or healthcare practice is crucial. A higher clean claim rate results in faster payments, a higher reimbursement rate, and an improved revenue cycle. Following are some tips according to the American Medical Association (AMA), American College of Radiology (ACR), and Centers for Medicare and Medicaid Services (CMS):
- Radiology report must meet all the documentation requirements:
If it is not documented, it didn’t happen. The radiology report must contain all the minimum documentation requirements. It must contain:
– Name of the study (Heading)
– Number of views (name of the views or sequences – highlighting what test was done)
– Reason or medical necessity behind the exam (clinical indication)
– Report of findings (body of the report)
– Conclusion (synopsis or summary of the findings)
– Signature of the physician
– Plain films (diagnostic studies)
Ensuring proper medical billing and coding process involves everyone from the coding department to the physicians. Radiologists must document all the details with clarity and consistency so that medical coders can use the specific codes in the medical claim. The documentation must indicate the reason behind the test, the diagnostic test performed, and the findings.
- Know the difference between technical and professional components:
A radiological report comprises the technical and professional components. Technical component includes the use of equipment, supplies, and any costs related to the “performance of the exam.” The professional component of the radiology billing consists of the physician’s services, dictated reports, and supervision.
- Code against the documented number of views only:
The number of views of the radiology report should be documented according to the basic requirements of CPT codes. The report must contain the exact number of views in the medical report.
The documentation is still acceptable even if the report mentions “AP, lateral and both obliques” instead of “four views.” Medical coders need to count the number of views and choose the correct CPT code. The CPT code for reporting this is 73564 Radiologic examinations, knee; 4 or more views,
- Documentation for a “Complete Exam” must also be complete:
Note that when a complete diagnostic exam is done, the documentation requires a list of everything included in the test. For instance, for the complete abdominal exam, documentation must include
– Inferior vena cava
– Upper abdominal aorta
– Gall bladder
– Common bile ducts
Documenting all of these anatomies is necessary; forgetting anyone can result in code being altered.
Outsourcing Radiology Medical Billing Services:
Medical billing is very crucial for any healthcare practice, and even the slightest mistakes can result in claim denials. The effectiveness of a billing procedure is very important in radiology practice. Compromised radiology billing results in lost revenues and missed reimbursements. There are several benefits of outsourcing medical billing of radiology practice to any of the well-reputed radiology medical billing companies. Yes, having an in-house medical billing department may mean you can have full control over your billing. But there are a number of drawbacks along with it. Medical billing for radiology requires complete focus and is a time taking process. As a radiology practice, you can outsource medical billing for any of the following radiology components:
– X-Rays or Computed Tomography (CT) Scan Billing
– MRI Billing Services
– Ultrasound Billing Services
– Nuclear Medicine Scan Billing
If you are thinking of outsourcing your medical billing services, below is the list of benefits you get by outsourcing medical billing services.
Benefits of outsourcing medical billing:
There are a number of benefits of outsourcing medical billing services:
– Increased revenues, cash flows, and reimbursement rate
– Lesser administrative responsibility
– Reduced errors, costs, and expenses.
– A team of professional medical billers
– Increased focus on patient care.
Why outsource to UControl Billing?
UControl Billing is a well-reputed medical billing company with years of market research. With a team of professional and well-trained medical billing specialists working to:
– Increase the reimbursement rate
– Reduce the overall expenses
– Provide the healthcare practice with uninterrupted service and stability.
– All of this while offering the clients competitive and affordable pricing.
With UControl Billing, you get:
– Improved Quality and Increased revenues
– Billing in 24 hours
– Timely follow-ups
– Patient support and customer service.
We offer 100% privacy, discretion, and confidentiality of patients’ information. By outsourcing your medical services to UControl Billing, you will have a feeling that we are right there with you. We consider ourselves as a “Remote Business Office,” always ready to respond to any queries and needs of our clients.
Frequently Asked Questions (FAQs)
What is radiology medical billing in medical billing?
Radiology is the field of medicine dealing with diagnostic procedures and medical imaging tests like X-Rays, CT scans, MRIs, PET, etc. Medical billing for radiology comprises of two components, the professional component (physician’s analysis) and the technical component (diagnostic exam).
What are common radiology medical billing errors?
Detailed documentation is very crucial for radiology medical billing. The radiologist must document all the details regarding a test, from the procedure’s clinical necessity to the procedure performed to the report. Incorrect or incomplete documentation leads to the use of wrong codes. Other common errors include; missed views, incomplete documentation of complete exams, and confusion between technical and professional components.
What does Radiology medical billing mean?
Submitting a medical claim against the radiology services rendered requires a high level of expertise in the department. Medical billing for radiology involves everyone from radiologists to the coding department. Because if the radiologist doesn’t document everything related to the procedure in detail, it results in the use of incorrect codes. Claim denials result in loss of reimbursements for the healthcare practice.
A couple of years ago, I executed the effective plan of creating a Medical billing and Coding company named U Control Billing. The company aims to bring revolutionary advancements to foster medical billing and coding revenues. As an official member of HIA-LI and MGMA, I feel honored in providing networking opportunities, problem-solving, and improving the revenue management cycle.