HAP Radiology Billing and Coding Blog

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.”

Nearly a year passed between the announcement by the Centers for Medicare and Medicaid Services (CMS) that Medicare coverage would be available for low-dose computed tomography (LDCT) lung cancer screening and issuance of the regulations that would allow claims to be submitted.  The patient eligibility requirements and the details for performing the exam were announced in February 2015 but it took the rest of the year before the billing and reimbursement particulars were known.  Finally, Medicare will pay for LDCT procedures performed on and after February 5, 2015 beginning in 2016. A 43-page decision memo from CMS defines in great detail the criteria that must be met by patients, physicians, and imaging centers in order for the scans to be eligible for reimbursement.  Here is a practical summary of the rules for performing and billing these screening services.

Now that 2016 is in full-swing, the new realities of our changing healthcare economy are becoming very apparent to providers across all specialties, and radiology is no exception. As physician practice leaders, assessing how to maintain and grow your practice as the transition to value-based compensation continues is not an easy task.  At Healthcare Administrative Partners, our mission is to educate practices on these matters and provide a path to optimized performance even in the most challenging markets.  Our continuing series of articles, “A Program for Successful PQRS Participation for Radiology Practices,” is specifically designed to help you maximize reimbursement and reduce compliance issues under the Physician Quality Reporting System (PQRS).  So far we’ve covered:

Congress has mandated that the Centers for Medicare and Medicaid Services (CMS) move forward with quality-based programs and associated payment models. In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law, expanding the Medicare quality-reporting programs that began as a voluntary incentive ten years ago with the original Physician Quality Reporting Initiative (PQRI).  Today it is more important than ever to embrace and maximize success in these programs and be ready to move ahead as they evolve. 

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. 

A variety of federal legislative activities during 2014 and 2015 contained rulings that will begin to affect Medicare reimbursement to physicians next year. Most recently, The Centers for Medicare and Medicaid Services (CMS) issued its Medicare Physician Fee Schedule (MPFS) Final Rule for 2016 that will govern its payments to physicians.  The overall impact of the final MPFS changes to radiology and radiation oncology practices compared with the proposed changes issued earlier this year, is estimated by CMS as follows:

In this blog article that continues our series on how to optimize radiology documentation for maximum reimbursement potential, we address the two most important questions specific to imaging guidance in interventional radiology. Imaging guidance is more and more frequently bundled with the primary interventional procedure, especially with the new CPT[i] codes proposed for 2016. It is, however, still separately billable in certain cases. Regardless of whether it is bundled or not, the radiologist’s documentation for the procedure requires certain elements that thoroughly describe the guidance methods and results. Here are the answers to the two most important questions for your radiology practice to consider.

The annual cycle of revising codes in the Current Procedural Terminology¹ (CPT)® has been completed with the issuance of the Medicare Physician Fee Schedule (MPFS) Final Rule for 2016, and radiology is one of the areas most affected by the changes.  The traditional radiology section of codes, 70010 – 79999, has 60 additions, revisions or deletions and there are even more when the Interventional Radiology (IR) surgical codes are considered. 

Medicare’s required changeover to ICD-10 diagnosis coding has shed more light than usual on a topic that requires constant diligence by radiology practices. Regardless of the payer being billed, good procedure coding and diagnosis coding are a must – and the source material for that coding is the documentation found in the radiologist’s report of the imaging examination.

As with any medical procedure, the performance of abdominal ultrasound examinations is defined by specific practice parameters. Likewise, the documentation of those exams must also comply with certain criteria in order for the practice to realize full reimbursement for them. The accepted guideline¹ for the performance of abdominal or retroperitoneal ultrasound exams indicates, “Depending on clinical indications, an examination may include the entirety of the abdomen and/or retroperitoneum, a single organ, or several organs.” Similarly, the documentation must contain an exact description of the procedure for proper billing.