The 2020 annual update to the ICD-10-CM[i] system used in medical insurance claim billing became effective on October 1, 2019. Twenty-one (21) codes were deleted, thirty (30) codes were revised and 273 new codes were added. The good news for radiologists is that relatively few of these changes will affect your work.
A radiology practice that performs interventional procedures will want to be up to date on the use of documentation and coding techniques for Evaluation and Management (E&M) services. These CPT® codes in the 99xxx range are less commonly utilized in radiology practices. Identifying circumstances where E&M services are billable, and then properly documenting and coding for them, will require a collaborative effort between the interventional radiologist (IR) and his or her coding team.
The Medicare Physician Fee Schedule (MPFS) for 2017 contained some revisions to the coding and reimbursement for moderate sedation that will potentially impact radiology practices. Previously, moderate sedation was not separately reimbursed for many of the procedures listed in Appendix G of the CPT®[i] codebook. Sedation was bundled with the basic procedure, but now it will be reimbursed in addition to the basic procedure. There are important guidelines and documentation that must be met in order to use these codes, and radiologists interested in maximizing their reimbursements should review their reporting to be sure it supports proper coding under the new rules.
Medicare publishes its rules and requirements for the coding and billing of medical procedures to obtain reimbursement under its programs, but many commercial insurers are not as transparent about their own requirements. This leaves medical billing professionals in the dark when there are new procedure codes or changes to existing coding in the American Medical Association’s CPT® code set or by federal regulation. Such is the case with mammography coding for 2017. Below we have summarized the key coding considerations for radiology practices billing mammography services this year. (Click here to read our complete article on the 2017 coding changes impacting diagnostic and intervential radiology.)
The annual cycle of revising codes in the Current Procedural Terminology (CPT)® has been completed with the issuance of the Medicare Physician Fee Schedule (MPFS) Final Rule for 2017. For diagnostic radiology, the changes this year are in mammography bundling, ultrasound screening for abdominal aortic aneurysm, and fluoroscopic guidance. Interventional Radiology (IR) will also be subject to bundling and other rearranging of codes for certain procedures. Finally, there are new codes that have been created to describe procedures previously unlisted, which generally will improve reimbursement for those procedures, and codes deleted from use, which will return the affected procedures to the ‘unlisted’ category.
Our first article in this series provided a list of questions to ask when evaluating a professional services Revenue Cycle Management (RCM) vendor for your radiology practice. If your current RCM vendor cannot answer all of them positively, it’s time to look for a new vendor. With a large number of RCM companies available in the market, how should you decide which one to choose?
When a major hospital-based radiology practice realized that their outpatient volume had dropped suddenly, their Revenue Cycle Management (RCM) company stepped up to quickly diagnose the problem. Using their analytic database, they produced a focused referring doctor report that revealed significant outpatient service volume declines concentrated among a handful of providers, one of which had decreased by 60%. It’s this kind of responsiveness that sets a true RCM partner apart from the average vendor.
The Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), Andy Slavitt, recently posted this blog article that describes the successful transition to ICD-10 diagnosis code reporting on October 1, 2015. In it, Slavitt writes, “For thousands of physicians and other clinicians around the country, the change to ICD-10 was a big undertaking, requiring time, planning and a period of adjustment. But on October 1, proper execution and good implementation made all the difference.”
One of the new coding requirements imposed by Medicare for 2016 is that practices attach a billing modifier to CT procedures performed with older CT equipment that does not meet the standards of NEMA XR-29-2013. Medicare’s payment for services billed with the new “CT” modifier will be reduced by 5% of the technical component. Both the Radiology Business Management Association (RBMA) and the American College of Radiology (ACR) have posted blog articles this week about the new requirements.
In our two recent articles we covered the effect of changes to codes in the Current Procedural Terminology1 (CPT) for diagnostic radiology and radiation oncology. Now we turn our attention to CPT code changes for 2016 that affect interventional radiology (IR). As before, our analysis focuses on the effect those changes will have on practice revenue. Each practice’s experience will vary based on the volume of procedures that use the affected codes, and a volume-weighted analysis of the entire Medicare fee schedule is recommended to gain a complete understanding of the impact to the practice.