Coding/Billing

If your radiologists perform reads in a different geographic location from where the patient received their service, you may have more credentialling requirements than you realize

Nonphysician practitioners may be able to perform and bill for services independent of a physician, depending on the Centers for Medicare and Medicaid Services (CMS) guidelines and state scope of practice statutes.

Just because there is a procedure code for a service does not mean that it is accepted and/or reimbursed for all payers.

CMS believes that the earliest that its claims processing system can begin screening claims using the AUC program claims processing edits for the payment penalty phase is October 2022.

In some practices there are situations that arise where the radiologists are asked to interpret images, aka “spot” images, in conjunction with other procedures, typically performed by other specialties.

Computed tomography (CT) and computed tomographic angiography (CTA) are imaging studies that continue to see increases in volumes and are targeted by the payers for medical necessity and coverage.

The proper use of ABNs is very important in radiology since many radiology claims are denied for medical necessity – specifically, the lack of a covered diagnosis.

Radiologists perform Evaluation and Management (E/M) services and may bill for them. However, it is important to distinguish between a separate E/M service, and the interaction with the patient that is related to and inherent in a procedure provided on the same date of service.

The guidelines for the ordering of diagnostic tests in the non-hospital setting have been around for 20 years.

Patient relationship categories and modifiers have been around for a number of years, but their utilization is not mandatory, and it is unclear when and if this will occur.