The growing sub-specialization of interventional radiology is making many procedures much less invasive and less painful for patients, but as with everything new, incorporating it into the existing system of medical billing codes can confuse new radiology billing services.
The Growing Sub-specialization of Interventional Radiology
The use of radiology imaging such as ultrasound, MRI, CT and x-rays to diagnose disease of internal organs and the vascular system has proven to be an effective and minimally invasive way to determine what is going on with a patient. As new technologies develop and the devices used in radiology become even more accurate and sensitive, new uses are being found, and diagnosis is becoming more productive, so the practice will continue to grow more and more useful.
The real expansion in the field is the addition of treatment procedures. Interventional radiologists are doctors who are board-certified in interventional radiology in addition to diagnostic radiology. Some of the more well-known methods are balloon angioplasty and catheter-delivered stents.
Their high-tech tools allow interventional radiologists to apply the latest technology to treat patients with the most minimally invasive procedures to date. These include the targeted treatment of cancer, blood clots, and diseases of the arteries and veins, among others. Recovery from minimally invasive procedures is easier on the patient, but additional benefits include reduced hospital time (which insurers appreciate as well as patients) and lower risk of infection.
Billing and Coding for Interventional Radiology
Evolving technologies are much more difficult to code and bill correctly because there isn’t always a set procedure. Efficient medical billing requires experience in addition to education, and no one has experience with something when it is new. This is one area where professional radiology billing services can be much more useful than in-house billers because a more extensive billing staff is more likely to have people with similar experience and be able to dedicate billers to that subspecialty so that they can become familiar with all the new codes that relate to the latest procedures.
Insurers are generally conservative about adding coverage for new things, so there is often extra documentation required. Professional billers can more easily stay on top of these additional details and the coding modifiers that are needed. Because the equipment needed for these procedures is costly, interventional radiology practices can’t afford to get paid for services just because the coding wasn’t correct.
Considerations for Interventional Radiology Billing Services
The basics of medical coding and billing are the same for radiology as for any other field of medicine. Still, there are a few things that need a little extra attention to ensure proper claim filing for interventional radiology.
- Differentiating consultations and office visits: Often, a physician will want input from another doctor regarding the evaluation and management of an issue that has been (or is being) diagnosed. The consultation must be documented in the patient record and billed as such; however, if the patient sees a different doctor for a second opinion on their own, it is billed as an office visit. Medicare Exception—Medicare does not allow reimbursement for consultations, so in that case, it is billed as an office visit.
- Inclusion in surgical bundles: Many surgical procedures are billed with a bundled code which includes all expected services and providers. These may consist of the initial visit for determining whether to perform the process, so billers must make sure that the office visit or any other included items aren’t billed separately.
- Level of service: Different codes are used to document whether the patient visit was inpatient or outpatient and new or established patient.
- Variable coverage: Particularly with new technologies, it is vital to confirm that the procedure is covered by the insurer before action is taken, and to be sure to find the correct code and appropriate modifiers to file for reimbursement.
Medcare MSO is an established medical billing and revenue cycle management (RCM) company with a large staff of experienced medical billers. Our innovative approach includes operating as a customer service business, and we assign dedicated project managers to each client so you can always speak to someone who knows your business and is available to help. Give us a call at 800-640-6409 to get more information and find out how we can increase your bottom line—while freeing you up to focus on patient care.