HAP Radiology Billing and Coding Blog

The Centers for Medicare and Medicaid Services (CMS) has issued its proposal for payments in 2025 under the Physician Fee Schedule (PFS), and it contains an across-the-board 2.8% cut from the current 2024 payment rate. This reduction in payments continues a trend that has seen the Medicare fee schedule reduced nearly 10% over the past 10 years. Last year’s proposed rule (for 2024) contained a 3.36% cut that ended up being a 1.77% cut after Congressional intervention in March, and it is possible that similar action will occur again. The Conversion Factor (CF) in the 2025 Proposed Rule is $32.3562, compared with the $33.2875 currently in use.

The importance of accurate and complete coding cannot be overemphasized for any area of radiology, but the complexity of interventional radiology (IR) coding makes it even more critical for optimal reimbursement. The prerequisite for complete coding is thorough documentation that includes all of the required elements, along with a coding team that is highly trained in IR.

At the April 14 – 17 Radiology Business Management Association (RBMA) PaRADigm Conference in Las Vegas, Rebecca Farrington and Sandy Coffta presented Positioning Your Radiology Group For Success. Their talk was a dive into a captivating exploration of real-world case studies from radiology groups that rode the waves of change. Whether the group soared to success or stumbled along the way, there's a story behind every strategic decision. Rebecca and Sandy unveiled the common pitfalls, the surprise twists, and the must-focus areas for crafting a winning strategy, including the informed choices that helped the groups navigate the intricacies of strategic planning.

The annual update to the Current Procedural Terminology^[1] (CPT)^® for 2024 has 230 new codes, 70 revised codes, and 49 deleted codes. In addition, there are 395 new diagnosis codes contained in the ICD-10-CM^[2] update, about one-third of them describing new ways to capture accidents and injuries. Although relatively few of these changes will impact radiology practices, it’s essential to know what they are and adjust your practice systems accordingly.

The Centers for Medicare and Medicaid Services (CMS) announced its Medicare Physician Fee Schedule (MPFS) Final Rule for 2024, including provisions for both Medicare reimbursement and the Quality Payment Program (QPP).

Click here to read our 2024 code changes update article.

While only a few of the 225 new codes, 93 revised codes, and 75 deleted codes in Current Procedural Terminology^[i] (CPT)^® for 2023 will impact radiology practices, it’s essential to know what they are and adjust your practice systems accordingly.

Recently, a study by a joint task force of the American College of Radiology (ACR) and the Society of Interventional Radiology (SIR) pointed out the need for all diagnostic radiologists to have certain competencies in “Level 1” interventional procedures. Radiology Business reports that the aim of the task force was making recommendations for “broadening access to image-guided procedures for patient populations living in rural care settings or served by small IR practices.” According to the study abstract, “Radiology practices characterized as small and rural are challenged to recruit and retain interventional radiologists”, resulting in a failure to meet the needs of patients and others in these communities. Thus, having diagnostic radiologists with Level 1 competencies in small practice or rural health settings increases their ability to provide a wider range of needed services.

Arterial catheter embolization is an interventional radiology procedure that requires detailed documentation of the steps performed by the physician to maximize coding and reimbursement. The procedure places medications, embolic agents, or a radiopharmaceutical into a blood vessel to prevent abnormal bleeding, close off vessels, eliminate abnormal connections between arteries and veins, or to treat aneurysms or tumors. Common embolization procedures include the treatment of uterine fibroids or the destruction of liver tumors using y-90 radioembolization.

Most updates to procedural and diagnosis coding become effective at the beginning of the year, but there are always a few mid-year changes that occur. In recent years, coding has changed to accommodate the COVID-19 public health emergency, and there are a few additions this year as well. Along with those, we’ll also add some reminders about topics that we’ve covered before.

Will the requirement to use Clinical Decision Support (CDS) finally become a reality? The current timetable for the penalty phase of the AUC/CDS rule calls for it to begin on the later of January 1, 2023, or the January 1 following the end of the COVID-19 public health emergency (PHE). The PHE has just been extended another 90 days into July 2022, with no end in sight although there are some indications that it could end this year. One source reports that the Administration will give 60 days’ notice before ending the PHE. With this uncertainty, it would be wise for practices to be ready just in case!