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
Medicare’s requirement that ordering physicians begin to use clinical decision support mechanisms (CDSM) when ordering certain advanced imaging examinations will take effect next year, and most radiology practices are gearing up to be ready. Any CDSM will require a set of rules, or Appropriate Use Criteria (AUC), that will guide the decision-making process.
Categories:
medicare,
cms,
CDS,
AUC
Click here to read our 2024 code changes update article.
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.
Categories:
medicare,
medicare reimbursement,
interventional radiology,
MPFS,
CPT codes,
radiology,
diagnostic radiology
The Centers for Medicare and Medicaid Services (CMS) has combined its rule making for both the Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP) into one document for its 2019 proposal. This article will summarize the elements of each area that will most affect radiology practices if they are ultimately finalized and become law later this year.
Categories:
medicare,
medicare reimbursement,
MPFS,
Quality Payment Program,
radiology,
QPP
Recently reported developments in federal health care policy could change the direction radiologists are taking to maintain maximum Medicare reimbursement.
Categories:
radiology reimbursement,
medicare,
medicare reimbursement,
Quality Payment Program,
radiology,
QPP
Click here to read our 2024 code changes update article.
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.
Categories:
medicare,
medicare reimbursement,
interventional radiology,
MPFS,
CPT codes,
radiology
The regulations that will affect Medicare reimbursement for physician practices in 2018 have been released. They include the Medicare Physician Fee Schedule Final Rule (MPFS), the hospital Outpatient Prospective Payment System Final Rule (OPPS), and the Quality Payment Program Final Rule (QPP).
Categories:
medicare,
medicare reimbursement,
MPFS,
QPP,
OPPS
Four new HCPCS modifiers will be available for use beginning in 2015, according to a recent announcement by the Centers for Medicare and Medicaid Services (CMS). Known collectively as the –X{EPSU} Modifiers, they will be used to define specific subsets of the CPT Modifier -59 for a “Distinct Procedural Service”. The new modifiers are intended to offer more precise coding options that will allow practices to avoid potential payment delays, audits and reviews associated with modifier -59. CMS says that -59 is the most widely used modifier, covering a wide variety of circumstances such as to identify different encounters, different anatomic sites and distinct services. Because modifier -59 is so broadly defined, it is often used incorrectly and inappropriately.
Categories:
radiology billing,
medicare,
radiology coding,
medicare reimbursement,
modifier -59,
mppr,
X{EPSU} Modifiers,
cms
The Medicare Physician Fee Schedule (MPFS) contains lower reimbursement in 2014 for diagnostic imaging and interventional radiology due to revisions adopted by the Centers for Medicare and Medicaid Services (CMS) in the annual Medicare rules update published in December. Radiation oncology practices will see a slight increase in the fee schedule while freestanding radiation therapy centers are facing considerable reductions. Meanwhile, Congress took some action to defer even larger cuts but continues to leave the medical community uncertain of future payment rates for physician services.
Categories:
radiology reimbursement,
radiology billing,
medicare,
radiation oncology reimbursement
CMS, the Centers for Medicare and Medicaid Services, has announced that it will begin full enforcement of rules concerning physician orders that have been in place since 2009. These rules will impact radiology billing. Beginning January 6, 2014, claims submitted for imaging services will be denied if they do not accurately report the name and NPI number of the ordering/referring provider.
Categories:
radiology reimbursement,
radiology billing,
regulatory,
medicare
