nuclear medicine

On January 1, 2022, radiology practices and hospitals that perform certain imaging services for Medicare patients will be denied payment for those services unless they submit documentation that the ordering physician has consulted a Clinical Decision Support (CDS) system. This regulation was included a few years ago in Medicare rulemaking, but its effective date has been delayed several times. As of now, there is no reason to believe it will be postponed further, so practices that have not yet taken steps to install and implement a system have a narrow window of opportunity to get ready.

Click here to read our October 2020 y-90 radioembolization article Our 2014 article "Interventional Radiology Meets Radiation Oncology – The y-90 Story” focused on the documentation requirements that will assist coders to maximize reimbursement for this complex procedure. Those documentation tips are still valid today. This update reviews the 2017 state-of-the-art in coding for y-90 procedures.

Click here to read our October 2020 y-90 radioembolization article Interventional Radiology Meets Radiation Oncology – The y-90 Story When a physician is performing an interventional procedure valued in the range of $4,000 – $6,000 for the professional component, attention to thorough and accurate documentation is a requirement for maximal reimbursement. Each case presents its own individual set of circumstances and a well-constructed operative report will tell the story of the case step-by-step. Each artery or branch into which a catheter is placed for diagnostic imaging or intervention is assigned a separate CPT code, and so the operative report must describe with specificity each catheter placement. When these descriptions are in a logical, sequential order, certified coders say that this allows them to better understand every aspect of the case so they can then accurately identify and apply up to 45 CPT codes to maximize reimbursement for it. A descriptive evaluation of each artery supports payment of the codes that are submitted for reimbursement.