HAP Radiology Billing and Coding Blog

This concludes our series of articles designed to assist radiologists with the task of preparing their reports for maximum compliance with ICD-10-CM reporting to Medicare.  By fine-tuning your documentation you will be assured of the best coding and uninterrupted reimbursement under ICD-10.  The complete series is available on our blog page, which also contains additional information to help radiology practices with this major change.  

As with any medical procedure, the performance of abdominal ultrasound examinations is defined by specific practice parameters. Likewise, the documentation of those exams must also comply with certain criteria in order for the practice to realize full reimbursement for them. The accepted guideline¹ for the performance of abdominal or retroperitoneal ultrasound exams indicates, “Depending on clinical indications, an examination may include the entirety of the abdomen and/or retroperitoneum, a single organ, or several organs.” Similarly, the documentation must contain an exact description of the procedure for proper billing.

Healthcare Administrative Partners continues our efforts to help radiology practices make a successful transition to ICD-10 with this article, the third in our series focusing on how radiologists can fine-tune their documentation to assure the best coding and uninterrupted reimbursement.  Our previous articles covered Documentation for Pain and Documentation for Fractures and our blog contains additional information to help radiology practices prepare for this major change.  

This is the second in our series of articles designed to assist radiologists with the transition to ICD-10-CM, which will be used in place of ICD-9-CM for reporting diagnoses to Medicare beginning on October 1, 2015. Our goal is to help you fine-tune your documentation to assure the best coding and uninterrupted reimbursement under ICD-10. Our first article covered Documentation for Pain and we also previously posted other information to help radiology practices prepare for this major change.   A large number of diagnostic imaging exams deal with the assessment of fractures and the documentation of these exams will require some pieces of information that were not always included in radiology reporting until now.

By this time, most people working in healthcare are already aware of the deadline to begin using ICD-10-CM in place of ICD-9-CM for reporting diagnoses to Medicare on October 1, 2015. Healthcare Administrative Partners has previously posted information to help radiology practices prepare, and this new series of articles is designed to help radiologists fine-tune their documentation to assure the best coding and uninterrupted reimbursement under ICD-10. One of the major areas of concern for radiologists is in the description of pain for proper diagnosis coding. A survey of historical coding by radiology practices showed that 17 of the 100 most commonly used ICD-9 diagnoses were related to pain.

The use of 3D reconstruction along with CT imaging is quite common for many types of exams performed by radiology practices. In some cases it is a minimum requirement in order to bill for the exam that was intended, while in other cases it will garner extra reimbursement. Either way, it must be specifically documented in order for coders to properly bill for the procedures. In this article we will review the financial reasons for providing good documentation, identify when 3D reconstruction is required and when it is an additional charge, and finally understand the documentation requirements that will provide the maximum reimbursement in these various circumstances.

The American College of Radiology (ACR), Radiology Business Management Association (RBMA), and other similar provider advocacy organizations are busy analyzing and preparing responses to the Medicare Physician Fee Schedule (MPFS) Proposed Rule issued by the Centers for Medicare and Medicaid Services (CMS) recently.  According to the RBMA Washington Insider of July 14^th, “CMS estimates that if the provisions within the proposed rule are finalized, the overall impact of the MPFS proposed changes to radiology to be 0%, while interventional radiology would see an aggregate increase of 1%, radiation oncology a decrease of 3%, nuclear medicine a change of 0%, radiation therapy centers a decrease of 9%, and Independent Diagnostic Testing Facilities (IDTFs) a 1% increase.” 

Participation in Medicare’s PQRS program is important to radiologists in order for them to maintain full reimbursement under the Medicare fee schedule, and to perhaps earn a higher level of payment in future years.  Radiologists providing services in Independent Diagnostic Testing Facilities (IDTFs) will not be able to participate in PQRS, according to a ruling described in the June 16, 2015 issue of the RBMA Washington Insider.  This most recent guideline issued by the Centers for Medicare and Medicaid Services (CMS) clarifies past guidance by stating, “After further review, CMS is announcing that EPs [eligible professionals] who provide services under an IDTF or an independent lab (IL) (and on behalf of services provided by that IDTF or IL) are not able to participate in PQRS.  Therefore EPs who provide services [billed] under an IDTF or IL will not receive the 2015-2018 PQRS payment adjustments for services associated with the IDTF or IL”.  This reverses CMS guidance issued as recently as March, 2015.

A report issued by the Office of the Inspector General (OIG) on May 6, 2015 found that Medicare overpaid physicians approximately $33.4 million for services performed in facility locations that were incorrectly coded as performed in non-facility locations, such as ambulatory surgery centers and hospital outpatient departments.  The physicians identified in the audit will have to reimburse Medicare for the overpayments. 

Reimbursement rates for both Breast Ultrasound and Digital Breast Tomosynthesis (DBT) received a boost from the Centers for Medicare and Medicaid Services (CMS) this year.  Medicare adopted new CPT¹ coding that provides enhanced reimbursement for ultrasound services, and coverage was newly approved for DBT as an add-on to screening and diagnostic mammography examinations.  These changes were described in our article, The Impact of Coding Changes on Radiology Practices in 2015.  In order to fully realize the benefit of these new billing opportunities, proper documentation is required within radiology practices.