Navigating Radiology Billing: Key Components You Need to Know

Radiologists handle both interventional and non-interventional procedures. All your diagnostic imaging procedures and ultrasounds come under interventional radiology practice.

Non-interventional procedures include standard X-rays, CT scans, MRIs, and contrast studies. This also includes radiographs, multiple or single views, contrast studies, advanced tomography and various magnetic resonance imaging services.

To ensure a maximized reimbursement for your practice, you must use the accurate ICD-10 codes for all the diagnoses.

You’ll also need to use CPT codes, which are five digits with two-digit modifiers for procedures. The procedure must be medically necessary and backed by the correct ICD-10 code. Often, you may need to use multiple codes (radiology and surgical codes), especially when you need to report a full procedure.

It is always important to comprehend the critical steps involved in your radiology billing practices so that you can enjoy seamless cash flow and a healthy revenue structure at the end of a fiscal year.

Get an overview on radiology claim processing services

1) Patient registration and verification:

• This is the first step where you need to gather patient demographics along with exact insurance information.
• After capturing the patient information, you should verify a patient’s insurance coverage and eligibility for the particular radiology service that you are going to provide

2) Accurate documentation and coding process:

• It is crucial for you to go through the radiology report and medical records of your patients
• For accurate billing purpose, you must assign proper CPT and ICD-10 codes

3) Preparation of claims and timely submission:

• Gather all the necessary documentation
• Once you have gathered all the documentation, submit your claims electronically to the insurance companies within the specific submission timeline

4) Diligent claims processing and adjudication:

• Have an efficient mechanism to monitor the real-time claims status do diligent claim tracking
• If there are claim denials and rejections, handle them carefully

5) Payment posting and back reconciliation:

• Once you receive the payments from the insurance companies, post them into your billing system
• Reconcile all the payments with the billed amount to know the exact accuracy

6) Ensure efficient denial management and appeals:

• Investigate each denied claim and promptly resolve them
• Collect the resolved denied claims and resubmit them to insurance companies for reimbursements

7) Collect patient-payments and do follow-up:

• Create detailed patient statement and invoices
• Now, follow up with patients regarding the due amount so that you can collect payments from them on time.

We all know the fact that coding plays one of the most critical roles for your internal billing team and all the radiology billing companies. A single coding mistake can cause your practice to encounter the consequences like denied claims, payment delays and poor revenue structure. To avoid all the coding related pitfalls, your coding team needs to have a sound knowledge of CPT codes, HCPCS codes, and modifiers. Let’s discuss about these components one by one.

Get a detailed understanding of CPT codes:

You need to assign CPT codes based on the service type and anatomical site. Here are some frequently used CPT codes in radiology billing services:

1. 70010-79999 – Radiology procedures (range of codes covering diagnostic imaging)
2. 71045 – Chest X-ray, single view
3. 72125 – CT scan of the neck without contrast
4. 70450 – CT scan of the head or brain without contrast
5. 73721 – MRI of the lower extremity without contrast
6. 74177 – CT scan of the abdomen and pelvis with contrast
7. 76641 – When you need to document complete ultrasound of breast, this particular code should be assigned
8. 76805 – Ultrasound, obstetric (baby ultrasound)
9. 77067 – Screening mammography
10. 76536 – Ultrasound of soft tissues of the head and neck

For interventional processes, you must use specific surgical codes to describe the imaging procedures that you perform. Some of the major surgical codes that you need to frequently use are-

1. 32555 – Thoracentesis (removal of fluid from the chest) with imaging guidance
2. 36561 – Insertion of central venous access device (port), with imaging guidance When you have performed an imaging guidance for insertion of central venous access port, you must assign this code
3. 49440 – Insertion of gastrostomy tube (feeding tube) under radiologic guidance
4. 50200 – Renal biopsy (kidney), percutaneous, with imaging guidance
5. 75989 – Where you need to remove a foreign body based on the fluoroscopic guidance
6. 37220 -You need to assign this particular code where you need to perform imaging guidance for endovascular revascularization
7. 49083 – Abdominal paracentesis with imaging guidance
8. 47562 – Laparoscopic X-ray of bile ducts
9. 75952 – You must assign this code for documenting imaging guidance for spine surgery

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Understand the nuances of HCPCS codes:

When it comes to documenting medical services and supplies, you should use HCPCS coding system. These codes start with one letter (A to V) followed by four digits. You can also use numeric or alphanumeric modifiers with these codes to explain the procedure better.

Modifiers:

You can bill radiology services for both the physician’s work and the use of equipment or supplies. The technical component (TC) covers things like facility charges, equipment, supplies, and staff. The professional component (PC) involves reviewing the test, making conclusions, and submitting a written report. Modifiers are 2-digit codes that help explain a procedure in more detail, such as when procedures are repeated or done on both sides of the body.

When you’re billing just for the technical component, use modifier 52. If you’re billing only for the professional component, use modifier 26.

Some other modifiers that you often need to use are Modifiers like TC, 26, 52, 59, 76, 77, LT, RT, E1 to E4, TA to T9, FA to F9, and LA, which are used to indicate specific anatomical details or components in billing. TC and 26 are for technical and professional components, while the others show the exact location of the procedure, such as left (LT), right (RT), or different parts of the body.

By now, you might have already realized the fact that managing radiology billing practices is not a cup of tea for everyone. Your internal administrative team needs to possess sound domain expertise and experience and unfortunately, the majority of radiology practices do not have skilled resources to tackle all the tasks.

If you want to streamline a perfect radiology billing process where you can give your 100% on clinical care, hiring one of the best radiology billing outsourcing companies like Sunknowledge can be the most pragmatic business decision for you.

When you outsource to Sunknowledge, billing is easier for your radiology practice. Their expertise helps cut down on errors, speeds up claims, and keeps everything compliant with regulations. This can reduce costs by up to 80%, so you can spend more time focusing on patient care instead of complex billing tasks.