MEDICAL

Radiology Medical Billing

Radiologists perform both interventional and non-interventional/non-invasive procedures. Interventional radiology procedures include diagnostic radiology imaging and ultrasound, while non-interventional procedures comprise standard radiographs, single or multiple views, contrast studies, computerized tomography and magnetic resonance imaging.

To get proper reimbursement for the procedures they perform, radiologists need to execute proper disease and diagnosis coding or ICD-9 coding (using three-digit codes that are modified by including a fourth or fifth digit as characters following a decimal point), and procedural coding using Current Procedural Terminology (CPT), comprising 5 digits with 2-digit modifiers. The procedure will be considered medically necessary only with a supporting ICD-9 diagnostic code. Sometimes multiple codes, such as radiological and surgical codes may become necessary to report a full procedure. Cardiology medical billers have to be thorough with radiology CPT codes that are bundled with other CPT codes.When billing for radiology services, ‘upcoding’ (coding a higher or more complex level of service than what was actually performed) has to be strictly avoided since this is regarded as fraud or abuse. Another important factor is to ensure whether the services require prior authorization to be properly reimbursed by the carrier.

Radiology Codes

Radiology codes comprise the 70,000 series of codes organized by the method or type of radiology and the purpose of the service. They are subdivided on the basis of the type of service and anatomical site.

These include:

• Diagnostic Radiology                70000 – 76499
• Diagnostic Ultrasound   76500 – 76999
• Radiologic Guidance                 77001 – 77032
• Breast, Mammography             77051 – 77059
• Bone/Joint Studies                    77071 – 77084
• Radiation Oncology                  77261 – 77999
• Nuclear Medicine                     78000 – 79999

Interventionalradiologists use certain surgical codes to signify the procedures they perform.  Some major surgical codes include the following:

• Mechanical Thrombectomy: 34201, 34421, 34490
• Biliary Drainage: 47510, 47511, 47530
• Cholecystostomy Tube Placement: 47490
• IVC Filter Placment: 37620
• Biliary Stone Removal: 47630

HCPCS Codes

Medical services and supplies that are not included in the CPT coding terminology are listed in the HCPCS (Healthcare Common Procedure Coding System procedural codes). These are represented by 1 letter (from A to V) followed by four digits. Numeric or alphanumeric modifiers can be used along with these codes to clarify a procedure.

Billing for Radiology Services

Radiological service can be billed for the physician’s work as well as the use of equipment or supplies. The technical component (TC) includes facility charges, equipment, supplies, pre-/post injection services, staff and so on. The professional component (PC) involves studying and making inferences about the radiological test and submitting a written report with the findings. Modifiers are used to signify the technical and professional components in a radiological service. They are 2-digit numbers that are used to explain a procedure in more detail. They can indicate repeat or multiple procedures, such as radiographs performed bilaterally. When billing for the technical component only, the modifier 52 has to be used; when billing only for the professional component, the modifier 26 is to be used. In the latter case, a written report by the physician providing the services is required to avoid claim denial.

Some other examples of modifiers:

• -22 – unusual (increased) procedural service
• -32 – mandated services
• -51 – multiple procedures
• -66 – surgical team
• -76 – repeat procedure by same physician
• -77 – repeat procedure by another physician
• -LT, -RT, -TA to -T9, -FA to –F9, -LC, -LD, -RC – Anatomical modifiers

The global fee comprises the total payment due for the technical and professional components and this also requires a formal written report.

Billing for Professional Component

Physicians can bill for the professional component of radiology services provided for an individual patient in all settings regardless of the specialty of the physician who performs the service. Reimbursement will be given under the fee schedule for physician services. However, for radiology services provided to hospital patients, insurance carriers reimburse the professional component only under the following conditions:

• Services should meet the fee schedule conditions
• Services provided should be identifiable, direct and discrete diagnostic or therapeutic services given to an individual patient

Payment for the Technical Component

As regards the technical component or TC of radiology services furnished to hospital patients and to Skilled Nursing Facility (SNF) inpatients during a Part A covered stay, insurance carriers might not provide reimbursement. The fiscal intermediary (FI)/AB MAC makes the payment for the administrative/supervisory services offered by the physician, as well as for the provider services. The TC of radiology services offered for inpatients in hospitals, excluding CAHs or Critical Access Hospitals are included in the FIs/AB MAC payment to hospitals. In the case of hospital outpatients, radiology and related diagnostic services are reimbursed according to the Outpatient Prospective Payment System (OPPS) to the hospital. In the case of a SNF, the radiology services offered to its inpatients will be included in the SNF Prospective Payment System (PPS). For services offered for outpatients in SNFs, billing can be made by the provider of the service or by the SNF according to arrangements made with the provider. When the billing is made by the SNF, Medicare reimburses in accordance with the Medicare Physician Fee Schedule.

Radiology Billing Standards

Radiology services can be billed in a number of ways. Some of the services are split billable and the codes for these are separately reimbursed by different providers for the professional and technical component. The physician and the facility can bill for their respective component with modifiers 26, TC or ZS. In full fee billing, the physician bills for both the professional and technical components and makes the payment due to the facility for the technical component provided. In standard billing, the facility bills for both the professional and technical components and reimburses the physician for his professional component. Services that cannot be separately billed are not individually reimbursed for the professional or technical components. These codes are reimbursed only for one provider and must not be submitted with the 26, TC or ZS modifiers.

Assigning the Codes

• Medical documentation is carefully studied to identify the radiological service performed.
• Identify the anatomical site
• Find the terms in the CPT index
• Select the codes on the basis of radiology terminology
• See whether modifiers are to be assigned

The following skills are essential for accurate coding and billing for radiology services:

• Ability to review clinical issues and CPT, ICD-9 and HCPCS coding guidelines for interventional and non-interventional radiology

• Knowledge about the differences between diagnostic radiology codes and therapeutic interventional radiology codes

• Skill to review coding guidance for modifier usage with interventional radiology procedures

• Ability to code challenging case scenarios

Professional Coding Services for Accurate Billing and Coding

When it comes to coding, the radiologist faces two main issues: first, understatement of completed treatment could mean insufficient reimbursement; second, if the codes overstate the treatment, it could result in risk of abuse, repayments and fines. Another problem is the complicated and ever-changing directives with regard to CPT procedures.

Radiologists can resolve all these issues by going in for the services of professional medical coding companies. They have skilled CPT coders to do the job. With great attention to detail, in-depth knowledge of the coding system, application of basic coding principles, and thorough documentation, these companies offer accurate, customized and affordable radiology medical billing and coding services in quick turnaround time.Most of the professional companies utilize state-of-the-art billing software to guarantee efficiency and accuracy in billing and coding, for checking local coverage determination and so on to ensure that all claims are reimbursed.

About the Author

Radiology Medical Billing – Outsource Strategies International (OSI) is a leading medical billing company in the US committed to providing fast and efficient medical billing services.

CONSTRUCTIVES – 29 Mar 2011

First Responder Trauma Bag- Fully Stocked $95.98 UNIQUELY DESIGNED FIRST RESPONDER KIT FEATURES A RUBBERIZED BOTTOM PANEL, DELUXE SHOULDER STRAPS, VELCRO HANDLE CLOSURES, REFLECTIVE STRIPS, AND PADDED LINER WITH 12 ADJUSTABLE COMPARTMENTS. ALSO INCLUDES 3 RIP FREE POCKETS! Measures 20″W x 9″H x 13″D 5 1/2 Bandage Scissors Kelly 5 1/2″ Straight Forceps Mini Scalpel, Disposable Dixie Emergency Airway Kit cold compress Liquid Glucose Wire Spl…

Pro-Tec Athletics Short Sleeve Knee Support $18.99 The Tandem Sports Pro-Tec short-sleeve knee support is a comfortable sleeve that has the neoprene modified below the knee to allow for greater mobility. It includes a buttress below the patella for additional support….

Darco Toe Alignment Splint $8.49 The DARCO TAS Toe Alignment Splint is a cost-effective solution that provides superior post operative toe alignment after Hallux Valgus, Hammer Toe and Tailor’s Bunion procedures. This one-size-fits-all splint properly aligns your toe(s), helping relieve pain and pressure due to bunions, hammertoes or Taylor’s bunions (bunions that occur at the base of the fifth toe). A soft elasticized cotton ban…

Acoustic Magic Voice Tracker II Array Microphone – Acoustic Magic Voice Tracker II Array Microphone $340 Acoustic Magic Voice Tracker II Array Microphone The Acoustic Magic Voice Tracker II Array Microphone is a deluxe USB speech recognition and conferencing tool designed for use in lecture halls, office meetings, VoIP conferences and more. Redesigned with help and input from customer feedback on the original Voice Tracker Array Microphone , the Voice Tracker II (VT II) provides unbeatable sound fidelity and ease of use. The VT II incorporates a high-quality acoustic echo cancellation (AEC) algorithm which enables full duplex VoIP based conferencing, which means that all parties can speak and listen at the same time without any loss in sound quality. This feature eliminates the need for headphones, as the microphone differentiates between talkers and will not pick up and re-transmit sounds on the receiving end of the call. With USB primary audio output and power connection, the Acoustic Magic Voice Tracker II Array Microphone is streamlined for VoIP use, however the unique electronic ‘listening beam’ technology allows the VT II to be used for a variety of other industrial applications, including the legal, medical and educational fields. The innovative multi-element microphone design provides superb clarity and mic accuracy for the entire room, allowing multiple users to speak without the need to reposition themselves or the microphone. This feature also lets the VT II learn the location of the talker, which can be used to direct a camera or other device towards the sound origin. The high-quality electronic mic array also works great with automatic speech recognition software, providing accurate and concise transcription and playback. Truly a unique and affordable alternative to a majority of conferencing tools on the market, buy your Acoustic Magic Voice Tracker II Array Microphone from ActiveForever.com today! Acoustic Magic Voice Tracker II Array Microphone Features: Specially designed VoIP compatibility built in Electronically locates and automatically steers toward talker Rapidly converging AEC algorithm Headset quality recording without the headset Two stage spatial filtering for noise reduction Built-in high quality acoustic echo cancellation Multi-element microphone design maximizes pick up range Compatible with a wide variety of computer operating systems Works well with a variety of automatic speech recognition programs Acoustic Magic Voice Tracker II Array Microphone Specifications: Dimensions: 11.5 L x 1.5 W x 1.25 H Weight: 0.75lbs Range: 20 ft Frequency Response: 100Hz to 11,250 Hz Primary Audio Output: USB Analog Output: Mic or line level Scanning Range: 360° Microphone Elements: 6 Power: USB, 5V DC adapter Compatibility: Mac OS, Mac OS X, Windows 3.x, Windows 95, Windows 98, Windows NT, Windows 2000, Windows ME, Windows XP, Windows Vista, Windows 7 Warranty: 1 year limited warranty Returns: All returns

Sharps Disposal Containers – Stackable – 8 gallon – 13.75 x 14 x 13.75 – Case of 10 $158.95 Sharps Disposal Containers – Stackable Stackable containers used for sharps disposal. red and black, multiple sizes available – Sharps Cntnr 1 Qt Stackable

Fibre-Metal 1092 Lens Retainer Spring For 1096 And 1085 – Fibre-Metal 1092 Lens Retainer Spring For 1096 And 1085 $2.99 SPRING RETAIN 1096/1085 0

Radnor VB1 Series Safety Glasses With Clear Frame And Clear Anti-Fog Lens – Radnor VB1 Series Safety Glasses With Amber Frame And Amber Anti-Fog Lens $2.18 The VB1 Series Eyewear by Radnor features a durable, lightweight polycarbonate lens with a scratch-resistant coating in a destinctive wraparound single lens design. The flexible temple design allows the use of a variety of cords for greater convenience which increases wearer compliance. With three frame colors and five lens colors there is a stylish combination for everyone. Features: Wraparound single lens design Scratch-resistant lens coating Durable, lightweight polycarbonate lens Flexible temple design accommodates a variety of cords Block 99.9% of harmful UV rays Meets ANSI Z87+ Standard GLASSES SAFETY CLEAR FRAME VB1 CLEAR AF LENS 12/BX 144/CA

Radnor VB1 Series Safety Glasses With Charcoal Frame And Gray Lens – Radnor VB2 Series Safety Glasses With Charcoal Frame And Gray Lens $1.67 The VB1 Series Eyewear by Radnor features a durable, lightweight polycarbonate lens with a scratch-resistant coating in a destinctive wraparound single lens design. The flexible temple design allows the use of a variety of cords for greater convenience which increases wearer compliance. With three frame colors and five lens colors there is a stylish combination for everyone. Features: Wraparound single lens design Scratch-resistant lens coating Durable, lightweight polycarbonate lens Flexible temple design accommodates a variety of cords Block 99.9% of harmful UV rays Meets ANSI Z87+ Standard GLASSES SAFETY GRAY FRAME GRAY LENS 12EA/BX 12BX/CA

Uvex Flex Seal Indirect Vent Over The Glasses Goggles With Navy Blue Light Weight Silicone Frame, Shade 3.0 Green Uvextreme Anti-Fog Lens And Neoprene Headband $22.71 The Uvex Flex Seal goggle’s silicone construction and design offer exceptional advantages over other over-the-glasses goggles for all-day comfort, superior fit and climate adaptability. It fits over many prescription frames, and its contemporary, wrap-around lens increases viability and protection. The Flex Seal Goggle is the latest in OTG comfort and protection technology from Uvex. Features: Cured silicone body stays soft and supple in extreme temperatures Low profile and optically correct polycarbonate lens provides full field of vision Uvextreme anti-fog coating and indirect venting system minimizes fogging Lightweight, silicone body conforms to assure the highest level of comfort and eye protection Passes ANSI Z87+ and SCA Z94.3 Standards Benefits: Fits over most prescription eyewear Pivoting clips permit the wearer to position the goggle on a hard had or position the headband above the ears The most comfortable goggle you’ll ever wear GOGGLES FLEX SEAL BLACK SHADE 3 XTR LENS NEOPRENE BAND 1EA/BX

Fend-all Model 870 LF With Shade 6 Half Lift Front Filter Lenses – Fend-all Model 870 LF With Shade 6 Half Lift Front Filter Lenses $71.8 The Uvex 870 Series Klip Lifts for safety eyewear offer fast and convenient vision enhancement for a wide range of industries. Whether you work in steelmaking, welding and cutting facilities, foundries or glassmaking operations, you will appreciate the convenience of the flip-up feature. These lenses can be quickly flipped down for observing a melt or a weld, and flipped back up again when not needed. Movement through a full 180 arc is possible, allowing the filter lenses to be raised or moved completely out of your line of vision. GLASSES FLIP UP SHADE 6 FENWELD 1/2 LENS

Tas un texto $6 Tas un texto

Complete Medical Supplies 15064 Bed Assist Rail $77.71 The Drive Medical Home Bed Assist Rail provides assistance for getting in and out of bed. It can be used on either side of the bed. Removable handle. Easy quick and no tool assembly also comes in 2 pieces. Safety strap wraps around mattress or box spring to ensure a secure fit. Special extra long safety strap enables user to be in a single twin double queen or king size bed. It is made of powder coated steel for long life and easy cleaning. Handle with the “Mid Bar” creates easy grip for any height use. Rail dimension: 11.5W x 20.75H x 21.5D inches and Weight limit: 250 lbs.

Complete Medical Supplies 2675 Auto Blood Lancing Device $23.4 Uses Complete Medical Brand lancets. Quiet concealed mechanism. Convenient single trigger. Regular and deep punctures. Protective Case.

Complete Medical Supplies 3191 Wireless Wander Alarm $61.69 Now you can detect movement of a person from a bed chair room or doorway with this sensitive discreet monitor Chime can be set to sound at the monitor or send a signal to the small receiver that can be mounted or placed up to 100 feet away The chiming unit takes one 9V transistor battery and the door switch takes a specialty battery A23

Complete Medical Supplies 10652 Light Switch Extender $29.45 An extension handle for your light switch A great device for children wheelchair users persons with tremors or a weak grasp 14 (36cm) long this handle lowers a regular height light switch to a more convenient height A rubber cap fits over the light switch knob

Complete Medical Supplies 9911 Replacement Nebulizer Kit $19.02 Includes a disposable nebulizer with tee adaptor 7 foot oxygen tubing mouthpiece and reservoir tube. Essential Wellness Starts Here. We are committed to Innovative Products that will enhance your well being. Top Quality Manufactured to the highest specifications. Satisfaction ensured. Taking care of your body now will pay dividends later. Outstanding quality and value. Offering the best in wellness products.

Complete Medical Supplies 1125 Bath Rail FloorToTub $53.95 Attaches easily to side of tub. Extends to floor for maximum support. 34 Height from the floor to top of rail. Supports up to 250 lbs.

Complete Medical Supplies 10559 Foot Socker $31.03 Foot Socker provides assistance when donning your socks A scoop shaped trough holds the sock open while you slip your foot into them The rigid handle provides firm control as you slide your foot far enough into the sock so that you can use your hands to finish the application

Complete Medical Supplies 2617 Telescopic Shoehorn $33.46 The Telescopic Shoehorn can adjust from 12 to 30 in length Ideal for packing in your suitcase or overnite bag The angle of the shoehorn paddle can be adjusted for use while standing or sitting Includes a convenient wrist strap

Complete Medical Supplies 3104 Nail Clipper Magnifying $25.29 Easy to use 3X magnifier. Bright LED light makes it easy to see. ABS Plastic stainless steel clipper. 3 button cell batteries included. Attractive Display card. Angle adjustment.

Complete Medical Supplies 2432 Pedlar Resisitive Exerciser $61.43 Adjustable from 0 to heavy. Chrome plated steel. Ideal for geriatrics. Restores Muscle strength and coordination in the arms and legs.

Complete Medical Supplies 8900 Velcro Rubber Tourniquet $20.83 Each. Pinchless velcrotype closure. Size: 14 x 1 adult. Natural Rubber. Outstanding quality and value.