HAP Radiology Billing and Coding Blog

Coding And Documentation For Arterial Embolization on August 29, 2022

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 treatment of uterine fibroids or destruction of liver tumors using y-90 radioembolization.

Categories: radiology documentation, interventional radiology, IR coding

Mid-Year Radiology Coding Update and Other Reminders on July 29, 2022

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.

Categories: radiology coding, interventional radiology, low dose CT, radiology, Provider Relief Fund, telehealth

Appropriate Use Criteria (AUC) Penalty Phase Set to Begin on April 29, 2022

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!

Categories: interventional radiology, clinical decision support, CDS, radiology, appropriate use criteria, AUC

Strengthening Congressional Support Addresses Medicare Interventional Radiology Cuts on February 25, 2022

Interventional radiology is among those specialties hit hard by the clinical labor practice expense cuts in the 2022 Medicare Physician Fee Schedule (MPFS). The proposed Physician Fee Schedule for 2022 contained an estimated 9% cut to interventional radiology (IR), due primarily to the revision of the practice expense component of the RVU calculation. The MPFS final rule brought the IR cut down to an estimated 5% after reconsideration of some of the methodology employed in calculating clinical labor costs. However, this is a blended figure that ignores the much larger effect on the global reimbursement for office procedures than on the professional component for hospital-based procedures.

Categories: interventional radiology, interventional radiology billing, Medicare Physician Fee Schedule

Evaluation and Management Coding and Billing for Interventional Radiology on March 11, 2021

A radiology practice that includes interventional procedures has to be up to date on the use of documentation and coding techniques for Evaluation and Management (E&M) services. Since these CPT®[i] codes in the 99xxx range are less commonly utilized in many radiology practices, identifying circumstances where E&M services are billable, and then properly documenting and coding for them, will require a collaborative effort between interventional radiologists (IR) and their coding team.

Categories: interventional radiology, IR coding, interventional radiology billing, E&M, evaluation and management

Coding Changes That Will Impact Radiology Practices In 2021 on January 6, 2021


Click here to read our 2022 code changes update article. 

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

Current Coding and Documentation for y-90 Radioembolization Procedures on October 30, 2020

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

Medicare Announces Prior Authorization Requirement on July 23, 2020

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:

Categories: radiology reimbursement, radiology billing, interventional radiology, cms, interventional radiology billing

Update on Interventional Radiology Coding and Billing on May 30, 2019

Read our 2021 IR billing & coding article 

 

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.

Categories: radiology billing, medicare, medicare reimbursement, interventional radiology, radiology, interventional radiology billing

The Value of PICC Lines for Interventional Radiologists on April 16, 2019

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.

Categories: radiology reimbursement, medicare reimbursement, interventional radiology, PICC

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