Radiology Coding Services

REGULATORY CHURN: DIAGNOSTIC AND PROCEDURAL CODES FOR RADIOLOGY

The American Medical Association (AMA) announced 2021 CPT code set changes, stating 329 editorial changes, 206 new codes, 54 deletions, and 69 revisions (AMA, 2020). Many of the editorial changes are the result of the 2021 E/M office visit code revisions. However, there are editorial changes, such as guideline or parenthetical note changes, throughout the CPT Radiology, Surgery, Pathology and Laboratory, Medicine, and Category III Codes.

For this reason, coding teams must carefully review Appendix B and the new guidelines and notes each year. Appendix B contains all code additions, deletions, and revisions found in the manual, but CPT contains other additions because of online updates.

There are also Group Modifiers, Claim Adjustment Reason Codes (CARC) Remittance Advice Remark Codes (RARC) and Medicare Summary Notice (MSN) attached to each. Let us take PET scans for our example:

Billing Codes and Diagnosis for PET Scans:

• Contractors recommend using the appropriate CPT code from section 60.3.1 for dementia and neurodegenerative diseases.
• Diagnosis codes for PET Scans for Alzheimer’s Disease (AD) include ICD-10 codes: F03.90, F03.90 plus F05, G30.9, G31.01, G31.9, R41.2, or R41.3.

Denial Prevention and Remittance Advice:

• Claims submitted with an appropriate CPT code and a diagnosis code outside the specified range will be denied.
• Contractors advise issuing an Advanced Beneficiary Notice to patients before services if the correct diagnosis code won’t be present on the claim.
• Remittance advice messages include:
• Group Code: PR (patient responsibility) with GA modifier, otherwise CO (contractual obligation).
• CARC: 11
• RARC: N/A
• MSN: 16.48

Documentation Requirements for PET Scan Claims:

Medicare contractors stress the importance of maintaining comprehensive information in the beneficiary’s medical record, including:

• Date of onset of symptoms.
• Diagnosis of clinical syndrome (normal aging, mild cognitive impairment, or various stages of dementia).
• Mini mental status exam (MMSE) or similar test score.
• Presumptive cause (possible, probably, uncertain AD).
• Results of neuropsychological testing, structural imaging (MRI, CT), and relevant laboratory tests (B12, thyroid hormone).
• Number and name of prescribed medications.

Billing Changes and Effective Dates:

• NCD 220.6.20 for Beta Amyloid PET scans has been removed as of October 13, 2023.
• Coverage determinations are now made by the MACs (Medicare Administrative Contractors).
• Effective from September 27, 2013, to October 12, 2023, CED is allowed for PET beta amyloid imaging.
• Claims lacking specific requirements, including condition code 30, value code D4 (FI only), appropriate modifier Q0, ICD-10 dx code Z00.6, PET HCPCS code (78811 or 78814), and specified diagnosis codes, will be returned as unprocessable.

CPT RADIOLOGY CODE UPDATES

• Minimal changes in the Radiology Section – two new codes, two deleted, and six revised.
• AMA revised three codes to include the word “diagnostic,” and added a code for CT thorax, low dose for lung cancer screening.
• The other new code captures medical physics dose evaluation for radiation exposure.

However, diagnostic codes alone won’t get you paid. They need to be paired with the appropriate HCPCS C, G, Q and R codes for items or services. Here are a few examples:

Dedicated Medical Coding Support for Radiology Centers

We employ certified coders who are experts in coding for radiology lab practices. Be it ICD-10, NCCI edits or place of service codes (POS), our coders have the necessary domain knowledge to ensure optimal billing – no missed or delayed payment and zero denied claims. Our teams have experience of handling high volume coding projects.

Medical coding has two other aspects that we need to talk about:

1. Its role in establishing medical necessity
2. Catering to Payer requirements

Moreover, we need to consider documentation management and clear channels of communication – factors that determine the actual impact of correct medical coding.

Our Team’s Tailored Radiology Coding Services

• Accurate reporting of ultrasound, CAT, MRI, PET, and mammography services with appropriate CPT codes.
• Expert coding for breast imaging, myelography, vertebroplasty, FEVAR, tumor ablation, and other radiology procedures.
• Skillful application of ICD codes for various conditions, from infectious/parasitic diseases to neoplasms and congenital anomalies.
• Proficient use of inpatient and outpatient consultation codes (E/M), modifiers, add-on codes, payer-specific codes, and procedure modifiers.
• Internal chart auditing, DRG/ICD-10 code validation, and regular QA checks for quality assurance.

We assist you in submitting clean claims and securing timely reimbursements by:

• Thoroughly analyzing documents and patient records.
• Meticulously checking modality details (e.g., MRI, ultrasound, CT, X-ray), anatomical sites, and views for accurate code assignment.
• Applying the right diagnostic imaging, guidance, or interventional codes to maximize reimbursement.
• Expertly separating technical and professional components, using relevant modifiers for precise billing.

Outsource Your Medical Coding Needs to Sunknowledge

Outsourcing to our Coding service can cut down on costs and massively boost your Radiology Practice’s bottomline.

Some of the key benefits of our Radiology Medical Coding Service:

• ICD-10 certified (CPC) coders
• Fast turnaround with advanced software
• Among the lowest FTE costs in the industry
• Instant cost savings of 80%
• 24/7 support
• Non-binding contracts
• 9% coding accuracy
• 100% HIPAA compliant
• Strict data security measures
• Proven track record
• 100’s of excellent client referrals
• Over two decades of domain expertise
• Immediate reduction in operational cost by 80%
• Error free patient entry
• Error-free charge sheets within agreed TAT
• We monitor, analyze and improve coding documentation to avoid denials and guarantee reimbursements

To learn more about our medical billing and coding services or to discuss your requirements with our experts, schedule a no-obligation call today.