Interventional radiology billing consideration

Medical Billing Considerations for Interventional Radiology Practices

Interventional radiology is a growing field that offers many benefits to patients. However, ensuring that you are getting the most out of your practice and meeting your patient’s needs can be challenging. In this blog, we’ll discuss tips for managing your interventional radiology billing services to maximize profits while maintaining quality care for your patients!

How Does Interventional Radiology Work?

Interventional radiology is a type of radiology that uses imaging technology to diagnose and treat disease. It’s a minimally invasive procedure that uses catheters, needles, and other devices to treat conditions like cancerous growths or blockages in the blood vessels. Fluoroscopy, MRI, CT, and ultrasound are used for all imaging modalities. 

Interventional radiology can be used to treat some of the most common diseases and injuries, such as:

  • Arthritis (inflamed joints)
  • Heart disease (heart attacks)
  • Cancerous tumors on the skin or internal organs
  • Angioplasty
  • Embolization
  • Gastrostomy tubes
  • Intravascular ultrasound
  • Needle biopsy

Interventional Radiology Billing and Coding 

It’s difficult to code and bill properly for evolving technologies because there isn’t always a specific procedure. Efficient medical billing necessitates experience and education, and no one has expertise in a new practice. Highly qualified radiology billing services can be more helpful than in-house billers. It would be beneficial to have an extensive billing team with similar experience and expert billers familiar with all the new codes related to the most recent procedures in this specialty area. Additional documentation is frequently required because insurers are usually careful about adding coverage for new things. Professional billers can keep track of this detailed information and coding modifiers more conveniently. Interventional radiology practices cannot afford to be paid for services that were not adequately coded because the equipment needed for these procedures is expensive.

Interventional Radiology Billing Considerations 

Medical coding and billing fundamentals are the same for radiology as for any other medical branch. Still, a few tasks take extra attention to guarantee proper interventional radiology claim filing.

Determine whether the service is billable separately

Medicare and other payers may consider the initial visit as a component of a surgical procedure. The concept of the Global Surgery Package is used to set the payment for electromedical and medical services. The global period begins on the day the procedure is performed and can run for up to 90 days following the operation. The purpose of an E&M visit is to determine whether or not a procedure should be performed. It is generally payable if it occurs outside of the GP’s office. All of the services related to the surgical procedure are included in the package and therefore are not reimbursable separately. 

For procedures considered to be major surgeries, such as those involving a 90-day general practitioner, E&M services may be performed on the day or the preceding day to decide whether or not to perform the procedure. This practice can be used to bill the patient’s E&M codes. Scheduling the patient’s initial visit at a time separate from the procedure can also allow the IR clinic to bill the E&M codes. The initial visit for certain GP procedures, such as those for 0 to 10 days, should be conducted no later than the day before the scheduled procedure. For 90-day procedures, the visit should be at least 2 days before the start of the procedure. In most cases, consultations on the same day or the day before the procedure will not be separately charged.

Level Of Service

Different codes are applied to document the patient visit, whether inpatient, outpatient, new, or returning patients. When billing for an E&M service, the level of coding is determined first by the location where it took place. The coding method will also be based on the time spent on a patient’s case. Typically, the level of coding for IR evaluations is lower than the other services. 

The table below summarizes the existing criteria for each level of outpatient coding:

Level of Medical Decision MakingTotal Time Spent On New Total Time Spent On
PatientCodeExisting PatientCode
MinimalN/A99211
Straightforward 15 – 29 min9920210 – 19 min99212
Low30 – 44 min9920320 – 29 min99213
Moderate45 – 59 min9920430 – 39 min99214
High60 – 74 min9920540 – 54 min99215

This method is easiest to determine since it considers the amount of time the patient spent on the service date. Total time is included in determining the time spent on a particular date with the physician or other healthcare professionals. This includes both face-to-face and non-face interactions. The time spent does not include other services performed by other healthcare professionals unrelated to a specific patient’s travel or the patient’s condition. For instance, when the professional’s interpretation of a diagnostic study is performed separately from the physician’s order, the time spent does not include. The level of medical decision-making can also be used to determine the level of coding. This is a fairly complex point system based on the number and complexity of problems addressed during the visit.

Consultations vs. Office Visits

A visit to the IR to discuss an interventional procedure’s propriety can often be referred to as a “consultation.” However, this term has specific requirements in the billing and coding process. A consultation is an evaluation or advice that requires an opinion or recommendation regarding a specific problem. A patient or a family member can initiate it, but it is not typically reported using consultation codes. Instead, it can be reported through the office visit codes. The 99241-99245 consultation codes offer a higher reimbursement rate than the office visit codes, but they require additional work. All of the ordered services and consultations must be documented in a patient’s medical record. This information is then communicated to the requesting doctor. Certain types of Medicare and other healthcare payers do not recognize consultation codes. For instance, if the tasks of sending a separate report and documenting additional documentation are performed, the appropriate office visit codes are used for those entities. However, under the new time-related rules for E&Ms, documenting and creating a separate report may result in higher reimbursement and coding.

Interventional Radiology Coding: Needs and Obstacles

  • An essential shortage of experienced interventional radiology coders makes it challenging to find one. They are expensive to attract and hire, and their ongoing “feeding” can be a substantial financial burden for businesses.
  • Interventional radiology coding expertise, training, and management resources are required. Interventional radiology coding is among the most challenging and complex techniques, particularly for neuro-angiographic procedures. The diverse collection of difficulties includes different vessel families and levels, transcatheter and endovascular treatments, and intraoperative radiography.
  • There is a high percentage of coding staffing levels due to the severe lack of interventional radiology coders. In addition to its other negative influences, turnover can induce a “whiplash” in cash flow, resulting in long delays and lost revenue.
  • A large interventional radiology practice is necessary to manage the employment of an interventional radiology coding expert financially. Most procedures, including those in tertiary medical centers, do not have enough patients to justify hiring an interventional radiology coder.
  • When it relates to interventional radiology coding, there is nothing like a “mulligan.” If your Medicare and insurance claims are not right the first time, your risk of failure increases. You can also lose revenue that cannot be recovered.

Advancements In Interventional Radiology 

As advancements in technology occur and radiology devices become more accurate and sensitive, new applications emerge, and diagnosis becomes more productive, the practice will become increasingly helpful. The introduction of therapeutic approaches is the proper expansion of the field. Success in interventional radiology is dependent on the unique needs of your team. As a new practice, you may not have an established group of highly trained radiologists or surgeons who can assist you with financial management. Building a strong billing team from scratch is essential. The best way to do this is by hiring someone with experience navigating insurance companies and patient responsibilities—and encouraging them to get involved through training programs and annual meetings. They understand their role within the practice and possible pitfalls that can arise during billing processes (e.g., missed claims). 

Interventional radiologists are board-certified in both interventional and diagnostic radiology. Balloon angioplasty and catheter-delivered stents are two of the more well-known methods. Their high-tech tools enable interventional radiologists to use cutting-edge advanced technologies to treat patients using the minor invasive procedures available. These include, among other things, the specific target treatment of cancer, blood clots, and artery and vein diseases. Recovering from minimally invasive procedures is easier on the patient. Still, there are additional benefits, such as shorter hospital stays (which insurers and patients both appreciate) and a lower risk of infection.

Conclusion

You can’t afford to get stuck in a cycle of repeating the same mistakes and falling victim to financial pitfalls. To succeed with interventional radiology, you must address these considerations as early as possible. The sooner you identify these issues and work on them, the less likely they will factor into your practice’s success or failure.

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