HAP Radiology Billing and Coding Blog

By this time, most people working in healthcare are already aware of the deadline to begin using ICD-10-CM in place of ICD-9-CM for reporting diagnoses to Medicare on October 1, 2015. Healthcare Administrative Partners has previously posted information to help radiology practices prepare, and this new series of articles is designed to help radiologists fine-tune their documentation to assure the best coding and uninterrupted reimbursement under ICD-10. One of the major areas of concern for radiologists is in the description of pain for proper diagnosis coding. A survey of historical coding by radiology practices showed that 17 of the 100 most commonly used ICD-9 diagnoses were related to pain.

The use of 3D reconstruction along with CT imaging is quite common for many types of exams performed by radiology practices. In some cases it is a minimum requirement in order to bill for the exam that was intended, while in other cases it will garner extra reimbursement. Either way, it must be specifically documented in order for coders to properly bill for the procedures. In this article we will review the financial reasons for providing good documentation, identify when 3D reconstruction is required and when it is an additional charge, and finally understand the documentation requirements that will provide the maximum reimbursement in these various circumstances.

Reimbursement rates for both Breast Ultrasound and Digital Breast Tomosynthesis (DBT) received a boost from the Centers for Medicare and Medicaid Services (CMS) this year.  Medicare adopted new CPT¹ coding that provides enhanced reimbursement for ultrasound services, and coverage was newly approved for DBT as an add-on to screening and diagnostic mammography examinations.  These changes were described in our article, The Impact of Coding Changes on Radiology Practices in 2015.  In order to fully realize the benefit of these new billing opportunities, proper documentation is required within radiology practices.

Will you have to be ready to use ICD-10 coding by October 1, 2015?  The answer is: "perhaps".  Current law says that this will be the earliest date for its implementation.  CMS, the Centers for Medicare and Medicaid Services, has stated that there will be no further extensions.  And, at the time of this writing, there is no indication that an ICD-10 extension will be included as part of legislation that would also extend the current Medicare fee schedule beyond its planned March 31^st expiration, but this could change as negotiations continue in Washington this week. 

As we have reported in a previous article, there are many good reasons to prepare for ICD-10 even if the Medicare program never requires it to be used!  The key to readiness is to improve clinical documentation so that the coding and billing team can do the best job possible to maximize your practice reimbursement, and this approach will also help improve your billing immediately.

Good documentation is the key to optimal coding and reimbursement for radiology procedures.  By including all of the essential elements in the radiology report, physicians give their coders all of the information they need to get the billing done most efficiently.  But when the report lacks some required piece of data, the coders must contact the radiologist for clarification.  At best, this slows down the billing process but, at worst, it leads to under-coding and therefore lower payment than is possible for the procedure.