Radiologists who perform venous ablation in a hospital outpatient department are now required to obtain prior authorization before performing such services on Medicare patients. This new requirement became effective for services performed on or after July 1, 2020, and physicians were notified by letters from the Centers for Medicare and Medicaid Services (CMS) late in June. The prior authorization requirement was included in the 2020 Hospital Outpatient Prospective Payment System (HOPPS) Final Rule, and encompasses the following procedures that might be performed by interventional radiologists:
Proper coding of physician services is essential to efficient billing and the optimization of reimbursement from payers, including commercial and governmental entities. The CPT® codes issued by the American Medical Association (AMA) to describe physician procedures are supposed to be recognized as standards, but in practice they are not accepted equally by all payers. One example is CPT codes in the range 99241-99255 that describe consultation services. These are most often used by interventional radiologists, as described in our article Coding and Billing Considerations in Interventional Radiology.
Interventional radiologists are often called to perform peripherally inserted central venous catheter (PICC) prodecures. Recent coding and policy changes bundle all imaging guidance and the confirmation of final placement into a single CPT® code. Let’s review the financial implications of those changes.
Our review of the proposed 2019 Medicare Physician Fee Schedule (MPFS) showed that 201 Professional Component (PC) codes and 213 Global codes were to be decreased by at least 1% in the Diagnostic Radiology 70000-series of CPT codes. In the final MPFS, only 46 PC codes were reduced by 1% or more, but 280 global codes were reduced by at least 1%. The number of codes expected to increase in payment did not change as dramatically, but in both PC and Global billing fewer codes were increased than we expected. Here are the details:
A recent study aimed at calculating follow-up recommendations in radiology reports and comparing the efficacy of various methods to identify patients in need of follow-up suggests the usefulness of technologies that can take action on those recommendations. The study that was conducted by Dr. Emmanuel Carrodeguas and his colleagues, published on December 29, 2018 in the Journal of the American College of Radiology and reported by AuntMinnie.com, concludes in part that “Automatic identification of follow-up recommendations could have wide implications for establishing and timely performance of collaboratively developed follow-up care plans for actionable findings in radiology reports to improve quality and experience of care for patients.”
Each year there are revisions of Current Procedural Terminology[i] (CPT)® that will impact the way radiology practices code their procedures and, ultimately, how they are reimbursed for those procedures. The majority of CPT code changes in radiology for 2019 are for Interventional Radiology procedures. Those that pertain to diagnostic radiology are in ultrasound, MRI, and nuclear medicine. We’ll cover the diagnostic codes first, and then go into detail on the interventional coding changes.
A study reported in the September 2018 American Journal of Roentgenology concludes, “A semi-automated approach to tracking patients with IVC filters can facilitate care coordination and clinical decision-making for a device with known potential complications.” The study followed 293 IVC filter recipients over a 6-month period, and found that the use of a tracking system improved the filter retrieval rate from 23% to 34% over the same period of the previous year.
CMS, the Centers for Medicare and Medicaid Services, is constantly on the lookout for procedure codes that it feels do not reflect the current cost or complexity of practice in their valuation. The annual Medicare Physician Fee Schedule (MPFS) rule modifies many codes with varying degrees of impact to radiology practices.
The recently issued Medicare Physician Fee Schedule (MPFS) Final Rule for 2018 tells us which of the revisions to the Current Procedural Terminology[i] (CPT)® have been adopted for use in the Medicare system, and how Medicare values those codes. The diagnostic radiology changes are fairly straightforward, but the Interventional Radiology (IR) coding for Endovascular Repair has been drastically altered with 20 new or revised codes.
When people are referred by their personal physician to a specialist, they usually see the specialist in his or her office for a consultation. Following the office visit, if the patient and physician deem a procedure to be appropriate, the procedure is scheduled in a facility such as an ambulatory surgicenter or hospital procedure room. Interventional radiologists, on the other hand, most often see their consultation patients at the time of the procedure in the hospital setting where the procedure will be performed, rather than in their own office. Changing this approach can yield benefits for the radiology practice, as well as for the patient.