HAP Radiology Billing and Coding Blog

One of the new coding requirements imposed by Medicare for 2016 is that practices attach a billing modifier to CT procedures performed with older CT equipment that does not meet the standards of NEMA XR-29-2013. Medicare’s payment for services billed with the new “CT” modifier will be reduced by 5% of the technical component.  Both the Radiology Business Management Association (RBMA) and the American College of Radiology (ACR) have posted blog articles this week about the new requirements. 

In our two recent articles we covered the effect of changes to codes in the Current Procedural Terminology¹ (CPT) for diagnostic radiology and radiation oncology. Now we turn our attention to CPT code changes for 2016 that affect interventional radiology (IR).  As before, our analysis focuses on the effect those changes will have on practice revenue.  Each practice’s experience will vary based on the volume of procedures that use the affected codes, and a volume-weighted analysis of the entire Medicare fee schedule is recommended to gain a complete understanding of the impact to the practice.

A variety of federal legislative activities during 2014 and 2015 contained rulings that will begin to affect Medicare reimbursement to physicians next year. Most recently, The Centers for Medicare and Medicaid Services (CMS) issued its Medicare Physician Fee Schedule (MPFS) Final Rule for 2016 that will govern its payments to physicians.  The overall impact of the final MPFS changes to radiology and radiation oncology practices compared with the proposed changes issued earlier this year, is estimated by CMS as follows:

There are relatively few CPT¹ coding changes for radiation oncology treatments in store for 2016, at least when compared with diagnostic and interventional radiology.  CMS, the Centers for Medicare and Medicaid Services, is still considering and revising a new set of codes for radiation treatment delivery that was proposed in 2015 but not yet implemented.  When implementation does occur, these codes will most likely not involve valuation differences, although this in an uncertainty until CMS takes action in some future year. 

In this blog article that continues our series on how to optimize radiology documentation for maximum reimbursement potential, we address the two most important questions specific to imaging guidance in interventional radiology. Imaging guidance is more and more frequently bundled with the primary interventional procedure, especially with the new CPT[i] codes proposed for 2016. It is, however, still separately billable in certain cases. Regardless of whether it is bundled or not, the radiologist’s documentation for the procedure requires certain elements that thoroughly describe the guidance methods and results. Here are the answers to the two most important questions for your radiology practice to consider.

The annual cycle of revising codes in the Current Procedural Terminology¹ (CPT)® has been completed with the issuance of the Medicare Physician Fee Schedule (MPFS) Final Rule for 2016, and radiology is one of the areas most affected by the changes.  The traditional radiology section of codes, 70010 – 79999, has 60 additions, revisions or deletions and there are even more when the Interventional Radiology (IR) surgical codes are considered. 

Medicare’s required changeover to ICD-10 diagnosis coding has shed more light than usual on a topic that requires constant diligence by radiology practices. Regardless of the payer being billed, good procedure coding and diagnosis coding are a must – and the source material for that coding is the documentation found in the radiologist’s report of the imaging examination.

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.