HAP Radiology Billing and Coding Blog

What the New Federal Law on Surprise Billing Means for Radiology Practices

The issue of patients receiving large, unexpected medical bills from hospitals and physicians has been widely publicized. This situation, known as surprise billing, arises when a hospital or physician provides medical care to a patient but is not participating in a patient’s insurance network. We have reported on the many states that have put legislation in place to try and mitigate the problem for their own residents, but now there will be a nationwide policy thanks to recent federal legislation.

Categories: radiology reimbursement, radiology, surprise billing

Small Radiology Practices Have a Narrow Window of Opportunity for Additional Provider Relief

From Wednesday, February 24 to Wednesday, March 10, practices with fewer than 20 employees will have a preferential opportunity to obtain a loan under the Paycheck Protection Program (PPP). According to the Small Business Administration (SBA), “This will give lenders and community partners more time to work with the smallest businesses to submit their applications, while also ensuring that larger PPP-eligible businesses will still have plenty of time to apply for and receive support before the program expires on March 31, 2021.”

Categories: radiology, COVID-19, Paycheck Protection Program

New Diagnosis Codes Related to COVID-19 Take Effect in 2021

Most of the annual changes to diagnosis coding under ICD-10[i] system take effect on October 1, but other changes occur during the year. There are quite a few codes that became effective on January 1, 2021, all related to COVID-19 conditions.

Categories: radiology coding, COVID-19

Understanding the Impact of The Medicare Fee Schedule for 2021 on Your Radiology Practice

When the Medicare Physician Fee Schedule (MPFS) Final Rule was published in December, it looked like radiology was facing a significant cut in Medicare reimbursement for 2021. Our article reported that professional component fees would drop 10-11% while global reimbursement would see a lesser impact. The Consolidated Appropriations Act, 2021 (CAA) rolled back those cuts at least for 2021, although the Medicare fee schedule for radiology will likely continue to be adjusted downward in the future as implementation of the revalued Evaluation and Management (E&M) services is fully phased in.

Categories: radiology reimbursement, medicare, medicare reimbursement, MPFS, radiology

How the Consolidated Appropriations Act Will Impact Radiology Practices

The “Consolidated Appropriations Act, 2021” (CAA) is a sweeping piece of legislation that provides relief to individuals and businesses impacted by the COVID-19 public health emergency. Some of the relief provisions apply to all businesses, including medical practices, but it also contains several measures that specifically apply to medical practices.

Categories: radiology reimbursement, medicare, medicare reimbursement, radiology, surprise billing, Paycheck Protection Program

Coding Changes That Will Impact Radiology Practices In 2021

The big news in Current Procedural Terminology[i] (CPT)® revisions for 2021 is the overhaul of the Evaluation and Management (E&M) section, reducing documentation requirements, and introducing new rules for determining the level of coding. These changes will affect interventional radiologists and radiation oncologists more than they will the day-to-day work of diagnostic radiologists. First, we will review the other non-E&M code changes affecting diagnostic and interventional radiology for 2021.

Categories: radiology coding, interventional radiology, IR coding, CPT codes, radiology, diagnostic radiology

Major Cut in Radiology Reimbursement For 2021 Is Finalized By CMS

The Centers for Medicare and Medicaid Services (CMS) has released the final set of rules that will govern the Medicare payment system for the coming year, thereby affirming the drastic cut in radiology reimbursement for 2021 that was proposed earlier this year.  There were few surprises in the Medicare Physician Fee Schedule (MPFS) Final Rule that were not contained in the proposed rule, other than a slight improvement in the fee schedule conversion factor and a change to the QPP Performance Threshold.

Categories: radiology reimbursement, cms, MPFS, radiology, QPP

Is it Time for Radiology Groups to Submit PPP Loan Forgiveness Applications?

It’s been a while since we looked at the Paycheck Protection Program (PPP) and its loan forgiveness feature. Since the beginning of the program in April it has undergone some revision, many questions have been answered, and yet the answers to some questions remain unclear. Currently there is much discussion of when to file the application for loan forgiveness, with renewed concern about the taxation aspects of the PPP.

Categories: radiology, PPP

ICD-10 Coding Changes For 2021 That Will Impact Radiologists

There are 490 new ICD-10-CM[i] codes that became effective on October 1, 2020, all of which are replacing existing codes. An additional 47 codes have been revised and 58 were deleted. Two new codes, U07.1 for COVID-19 and U07.0 for vaping-related disorders, took effect on April 1, 2020. They are contained in a new section of the guidelines, Chapter 22 “Codes for Special Purposes (U00 – U85)”.

Categories: radiology reimbursement, icd-10, radiology

Current Coding and Documentation for y-90 Radioembolization Procedures

The treatment of liver tumors using yttrium-90 (y-90) radioembolization brings unusual challenges for interventional radiologists (IR). Documentation of treatment planning, radiation dosimetry calculations and placement of radioactive sources are not usually a familiar part of their lexicon. It is these unfamiliar disciplines, along with more comprehensive Evaluation and Management (E/M) visits, that set this procedure apart from the more routine IR cases.

Categories: interventional radiology, y-90, interventional radiology billing

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