Radiology billing is the process to accurately code, submit and manage claims for imaging services done in a clinic. The radiologists treat conditions using MRIs, X-rays, and CT scans. Billing radiology procedures is a complex process as it has complicated coding and frequent modifier usage, spanning both interventional and diagnostic procedures. Always remember that your clinic can face delayed payment and lose a significant amount of revenue if they don’t have relevant experience in medical coding. So, the solution to this problem is to hire radiology billing solutions who can take care of this. Now, before diving into how they can help, let’s understand the guidelines of radiology billing.
Guidelines of Radiology Medical Billing
The two vital components of radiology billing are professional and technical components. Professional components include the expertise the radiologists provide in supervision in the imaging procedure, image interpretation, and written reports. Moreover, the technical components include equipment, supplies, and exam-related performance cost. Always remember that following all the radiology guidelines is important to get proper reimbursement. There are basically two types of coding systems used in radiology, such as ICD-10 and CPT. ICD-10 has two subsets in which the ICD-10-PCS is used for inpatient settings and ICD-10-CM has outpatient settings.
1) CPT Codes Used in Radiology Billing
The CPT codes are being used to describe all the services and procedures performed by radiologists. They use thousands of CPT codes, depending on the procedures or imaging studies performed. It has been observed that nuclear medicine has 2000 medical codes ranging from 78000-79999 and diagnostic radiology includes 6500 medical codes ranging from 70000-76499. Let’s dive into some other examples like:
- Code for diagnostic ultrasound: 76500—76999
- Radiologic Guidance code: 77001—77032
- Breast, and Mammography: 77051—77059
- Bone/Joint Studies: 77071—77084
- Radiation Oncology: 77261—77999
- ICD Codes Used in Radiology Billing
ICD-10 codes are used to describe all the patient’s medical conditions and diagnoses. The radiologists use ICD-10 codes to understand the reason for imaging study. Hence, when a patient undergoes a CT scan to investigate serious conditions such as cancer, the clinic use the ICD-10 code as the primary code of diagnosis.
2) Additional Usage of Coding
Apart from ICD and CPT codes, radiologists also use HCPCS codes for all the medical equipment, services and supplies which are not covered by the CPT codes. However, the interventional radiologists have different billing issues than the traditional radiologists, who use imaging technology to conduct all the minimally invasive procedures. Some of the medical codes fall under surgical CPT code section, as opposed to the codes used by the radiologists. That’s why interventional radiologists need to be well-versed in the surgical and diagnostic coding system to create an accurate billing process, starting from mechanical thrombectomy uses 37184 to 37186 code, biliary drainage has 47510, 47511, 47530 codes, cholecystostomy tube placement: 47490 and, IVC filter placement has 37191 code and for biliary Stone Removal, 47525 code is used.
You need to know that accurate coding leads to proper reimbursement. The clinics need to ensure that they are using the right code for the provided service, including any additional codes or modifiers if necessary.
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Challenges in Radiology Medical Billing
Most of the radiology billing challenges comes from misassigning the medical codes, which eventually leads to lost revenue or payment denials. The challenges include:
1) Technical versus Professional Components
Clinics need to use modifiers to differentiate between the technical and professional components. Sometimes the radiology procedures need to be coded in different ways depending on its billing process. The total reimbursement will depend on the technical and professional components for the services. It happens because the insurers and payers have different rates of reimbursement for different types of clinics.
2) Undercoding and Upcoding
Undercoding is billing for lower-level services than which was actually performed. Hence, it can lead to less reimbursements than the service provided, which eventually leads to lost revenue. On the other hand, upcoding is billing for higher-level services than the performed ones. It can lead to serious medical billing violations which result in legal action or fines. Hence, radiology billing services need to document and code all the provided services to make sure claims are accurately submitted.
3) Hire a Reputed Radiology Billing Team
As your healthcare staff takes care of almost all the healthcare operations, that’s why they don’t get the time to improve patient care. Here, the radiology billing outsourcing experts also know all the latest ICD, CPT, and HCPCS codes to protect patient data. Moreover, they also know all the ins and outs of the prior authorization process to verify patient’s eligibility, collect important documents and the submit PA request to protect patient data. Apart from that, they are less costly than the in-house staff because you don’t need to train them and also buy expensive office space for them. In addition to that, they are highly technology-agnostic as they know how to work with the clinic-specific EHR system to store patient data. Furthermore, they also know the Electronic Prior Authorization (EPA) procedure to submit claims electronically. Always remember that the right outsourced expert can make your clinic turn profitable in a whisker.
What the Future Holds?
The future of radiology billing looks promising due to the latest advancement in technology. So, before hiring any experts, check if they help with MRI, ultrasound, nuclear medicine, XRAY, and interventional radiology procedures. Moreover, these outsourced experts provide customized reports and weekly reports as per the client’s protocols. These experts also have a free transition process and can reduce your operational costs by 80%. Furthermore, these companies work with 99.9% accuracy and can provide you with 100’s of references so that you can trust them. These companies also have a dedicated account manager at no extra cost and have no binding contract or restrictive clause. They have less than two days of turnaround time and help with real-time patient eligibility checks. Hence, if you want to streamline your billing process, it may be a feasible option to outsource radiology billing services in that matter.