How To Enhance Practice Revenue Using Video Reporting

How To Enhance Practice Revenue Using Video Reporting Radiologists at NYU Langone Medical Center have been creating video radiology reports in addition to their traditional text-based reports. The videos are intended for the patient, not the referring physician, and they are uploaded to the patient portal as they are completed. A team headed by Michael P. Recht, MD, studied the results, which became available online April 20 at the American Journal of Roentgenology. An example of a video report is included in NYU Langone’s NewsHub.

The study showed that 864 of the 3,763 (23%) of the reports created over a 4-month period were opened, with 395 of them being viewed more than once. Tom Greeson of ReedSmith commented in his blog that, “In large part, such patient-centered reporting is the result of the information blocking provisions of the 21st Century Cures Act which has led a growing number of imaging centers and radiology departments to terminate report embargos and to provide patients immediate access to their written radiology reports.”

The goal of the NYU video reporting program was to provide patients with better understanding of their diagnosis. Dr. Recht explains, “Our findings demonstrate that when radiologists take a more active role in patient-centered care and provide helpful information about a particular diagnosis in an easy-to-comprehend manner, both the patient and clinician benefit.” However, they had to purchase and install an integration tool that would allow their PACS images to be selectively transferred to the patient portal, along with mouse-driven illustrations and the audio explanation by the radiologist. Is there any additional reimbursement for their altruistic effort?

For patient-directed video reporting, the answer is “No”. However, physicians may use video interprofessional reporting to communicate with other physicians. One practice we know of creates a video of their pre-procedural mapping for Transcatheter Aortic Valve Replacement (TAVR). The radiologists find the video to be useful in pointing out specific aspects of the TAVR mapping to the cardiologist who will perform the procedure.

The video report takes less than 10 minutes of the radiologist’s time to create, and it is produced in addition to the usual written report required by the underlying CPT^[i] codes for the mapping procedure. The video report is separately reimbursed by Medicare and certain other insurance payers such as Aetna, but others such as Independence Blue Cross (PA) consider it to be a bundled part of the procedure.

Here are the relevant codes and Medicare reimbursement for interprofessional reporting:

Code	Description	Medicare
Interprofessional telephone/Internet/electronic health assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional;
99446	5-10 minutes of medical consultative discussion and review	$18.69
99447	11-20 minutes of medical consultative discussion and review	$36.68
99448	21-30 minutes of medical consultative discussion and review	$55.02
99449	31 minutes or more of medical consultative discussion and review	$73.71
99451	Interprofessional telephone/Internet/electronic health assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes of medical consultative discussion and review	$36.34

The two codes that will be used most often are 99446 and 99451. Both require at least 5 minutes of physician time, but the distinction between the two is in how the time is used. The more highly reimbursed 99451 is to be billed if more than 50% of the 5-minute time is data review and/or analysis, while 99446 is used if the majority of the service time is devoted to consultative discussion. Of course, the higher-level codes (99447 – 99449) are available if more than 10 minutes is spent.

The reimbursement of $18.69 for 99446 on the national Medicare Physician Fee Schedule (2022) is about twice that of a single- or two-view chest x-ray for expenditure of a similar amount of time.

The CPT rules for any of the codes described above include:

They must be used by a “consulting physician”, which excludes their use by non-physician providers such as Physician Assistants or Nurse Practitioners.
The patient may be either new or established to the consulting physician, and may not have a face-to-face service with the consultant in the preceding or succeeding 14 days.
The codes may not be reported more than once in a 7-day period.
The request for the consultation and the reason for the consult must be documented in the medical record.

The use of video reporting directly to patients might increase now that greater, unrestricted access to medical records is required by law, and radiologists may find that creating a video at the same time as the interpretation is easier than answering a patient’s questions later. Video reporting, or interprofessional reporting using any electronic means, can also be a tool that will enhance the radiology practice’s revenue when it is appropriate for providing consultative reports to ordering physicians.

[i] Current Procedural Terminology (CPT) is a copyrighted code set developed and maintained by the American Medical Association, and CPT is a registered trademark.

Erin Stephens, CPC, CIRCC is the Sr. Client Manager, Education at Healthcare Administrative Partners.

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