Radiology covers a wide array of procedures and diagnoses, making billing compliance essential for a successful practice. Navigating the intricate coding, billing rules, regulations, and prior authorization requirements can be challenging. Additionally, the transition to value-based care and new payment models has affected radiology reimbursements. As a result, many practices rely on professional radiology medical billing services to ensure effective revenue management and seamless claims reimbursement.
Ensure radiology medical billing compliance and boost revenue!
Medscape Survey: Radiology Billing Compliance Poses Significant Challenges
According to recent survey data from Medscape, about 60% of radiologists and other physicians reported that their support staff is dedicating more hours to billing compliance than they did five years ago. Radiology Business highlighted that around 40% of respondents noted a “somewhat” increased workload, while 21% described the rise as “substantial.” Additionally, nearly two-thirds of physicians indicated that staff hours spent on processing prior authorizations have also increased over the past five years. Furthermore, 34% of physicians expressed dissatisfaction with current reimbursement rates. These findings are based on a survey conducted in February-March 2024, covering 1,030 physicians across 30 specialties, including about 30 radiologists.
This post provides an overview of what radiology providers need to know about ensuring billing compliance for maximizing revenue.
Best Practices for Radiology Billing Efficiency
The financial stability of radiology providers is closely tied to timely billing and reimbursement. Radiology providers deliver high-quality imaging procedures that assist physicians in diagnosing various conditions and determining appropriate treatments. The efficient operation of these facilities depends on accurate claim submission and prompt reimbursement. Here are some key strategies to promote efficiency in radiology billing:
- Accurate Coding
Radiology providers need to choose from thousands of codes to report type of imaging study or procedure performed.
CPT codes: The main CPT code categories for radiology are:
- 70010 – 76499 Diagnostic Imaging
- 76506 – 76999 Diagnostic Ultrasound
- 77001 – 77022 Radiologic Guidance
- 77046 – 77067 Breast Mammography
- 77071 – 77086 Bone or Joint Diagnostic Studies
- 77261 – 77799 Radiation Oncology
- 78012 – 79999 Nuclear Medicine
Radiologist also need to stay up to date with changing codes and guidelines. The following new radiology CPT codes became effective in January 2024:
- 75580 for reporting non-invasive estimate of coronary fractional flow reserve (FFR) derived from augmentative software analysis of coronary computed tomography angiography data.
- 76984, 76987, 76988, and 76989 in the radiology “other procedures” section for reporting diagnostic intraoperative ultrasound service.
ICD-10 codes: Radiologists use ICD-10 codes to document the medical diagnoses associated with imaging studies, ensuring that the reason for the exam is clearly indicated. Here are two examples:
R93.1 – Abnormal findings on diagnostic imaging of the heart and coronary circulation
M48.06 – Spinal stenosis, lumbar region
Interventional radiologists must be knowledgeable about both the diagnostic and surgical coding to ensure accurate billing.
HCPCS codes: Radiologists use HCPCS codes in conjunction with CPT and ICD-10-CM codes to report medical equipment, supplies, and services. HCPCS codes for radiology services include:
- R0070-R0076: Diagnostic radiology services
- A4644: Supply of low osmolar contrast material (100-199 mgs of iodine)
- A4645: Supply of low osmolar contrast material (200-299 mgs of iodine)
- A4646: Supply of low osmolar contrast material (300-399 mgs of iodine)
- Understand Professional, Technical, and Global Components
Most radiology services or procedures comprise two distinct parts: a professional component (PC) and a technical component (TC). Understanding and distinguishing these components is crucial for accurate billing.
- Professional component: The physician provides the professional component which may include supervision, interpretation, and a written report. To claim only the professional portion of a service, modifier 26, professional component, should be added to the appropriate CPT code. Modifier 26 is appropriate when the physician supervises and interprets a diagnostic test, even if they themselves do not perform the test.
- Technical component: The technical component (TC) of a service covers all equipment, supplies, personnel, and costs related to the performance of the exam. The facility or practice responsible for these costs can claim the TC of a service by appending modifier TC, technical component, to the appropriate CPT code.
For example, the CPT code 77046 denotes unilateral breast magnetic resonance imaging (MRI) without contrast material. When a radiologist performs the MRI in their private office, the professional component of the service would be billed using the CPT code 77046 with modifier 26 to indicate that only the interpretation and report of the scan are being billed, and not the actual scanning procedure.
On the other hand, if the same unilateral breast magnetic resonance imaging (MRI) is performed in an imaging center, the facility would bill for the TC of the service using the CPT code 77046 with modifier TC to denote that only the technical portion of the service is being billed. Hospitals are generally exempted from using modifier TC, as it is assumed that they are billing for the technical component of any on-site service.
Consult individual payers for specific coding instructions. For Medicare, check the National Physician Fee Schedule Relative Value File on the CMS website to identify codes with separate professional and technical components.
- Global component: The global component includes both the professional and technical components of a single service. A global service is when the physician owns the equipment and supplies and also plays a role in preparing the report. In this case, the professional and technical components are billed together and the TC and 26 modifiers are not appended.
- Complete and accurate documentation
Standardized documentation is critical to ensure accurate radiology medical billing and coding. Radiology services require a diagnostic test order from the referring physician. To ensure compliance, referring providers should provide a complete and accurate order that justifies the necessity of the radiology test, and clearly specify signs or symptoms prompting the need for the radiology study, such as pain, swelling, fever, shortness of breath, or nausea.
Radiology reports should adhere to American College of Radiology (ACR) guidelines, and include the following:
- Heading: Name of the study
- Number of Views/Sequences: Description of what was done
- Clinical Indication: Reason for the exam
- Body: Findings from the study
- Impression/Conclusion: Summary of findings
- Physician signature
Additionally, reports should:
- Use language that aligns with CPT code descriptors.
- Include separate subsections, such as technique and comparison, with distinct data for each.
With proper documentation, a radiology medical coding company would have the information required to report imaging procedures and services using the most specific codes.
Outsourcing – A Practical Strategy to Optimize Reimbursement
Outsourcing radiology medical billing and coding can help ensure adherence to best practices, industry standards, and compliance with regulations. A medical billing company that specializes in radiology billing can help radiology providers maximize revenue by implementing processes to validate interpretation reports, ensure accurate coding, submit clean claims, and ensure prompt and appropriate reimbursement.
Partner with our specialized radiology billing team and maximize reimbursements!
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