ICD-10 Diagnosis Coding in Radiology
Another component of the radiology billing process involves ICD-10 diagnosis coding. These codes document the necessity of the imaging study and explain why it was completed. It is essential that this component is accurate to ensure compliance and reimbursement for services provided.
For example, some of the ICD-10 diagnosis codes that apply to radiology include:
- R93.89: Abnormal findings on diagnostic imaging of an unspecified body structure
- K00-K95: Diseases of the digestive system
- RO7.9: Chest pain that is unspecified
Challenges Specific to Radiology Coding and Billing
Billing for radiology services requires careful management of the following common challenges.
Two components
Medical billing in radiology requires two to be met:
- Professional component (modifier -26): This is specific to the interpretation and written report completed by the physician after the imaging study is complete.
- Technical component (modifier -TC): This component focuses on the usability of supplies and equipment and the tasks completed by the technicians and technologists during the imaging study itself.
Global vs split billing
Global billing refers to a single claim that includes both the technical and professional components of a procedure. This typically applies when the same provider or entity performs and bills for both components—such as when a radiology practice owns the imaging equipment and also employs the interpreting radiologist. The global charge covers the use of the imaging equipment, supplies, and support staff (technical component) as well as the physician’s interpretation and report (professional component).
In contrast, split billing divides the technical and professional components into separate claims, usually because different providers are responsible for each part. For example, a hospital may bill for the technical component, while a radiologist who only interprets the image bills separately for the professional component using modifier -26.
Artificial intelligence (AI) and computer-aided detection (CAD)
A growing trend in radiology is the use of AI algorithms and CAD software. Both assist with image interpretation and tend to provide more accuracy and a faster deduction of the underlying condition. For example, computer-aided detection (CAD) software can detect even small anomalies in images, helping radiologists make critical decisions.
AI reimbursement models in imaging may be managed by one or several approaches:
- Bundling: In some situations, AI costs are included or “bundled” into the image exam price. This could increase a patient’s costs.
- Hospital absorption: Medical institutions will sometimes absorb the cost of this type of service.
- Compliance: Note that CPT codes for some procedures already incorporate some level of CAD. In these cases, billing separately may not be applicable.
Radiology Information System (RIS) and Picture Archiving and Communication System (PACS)
Another factor to consider for billing radiology services has to do with the systems in use. These two systems aid in the workflow management and storage of patient data and medical images. For example, RIS handles clinical and administrative data. PACS is where digital storage, communication related to images, and retrieval of those images occurs.
In medical billing for radiology, it is essential for these two components to integrate well with the billing system being used. Doing so ensures accurate charge capture and minimizes costly and time-consuming mistakes.
Documentation difficulties
One of the most common road blocks in radiology billing involves insufficient or inconsistent documentation. These issues often lead to denied or delayed claims. Common examples include:
- Mismatch between the exam order and the technique section: The procedure performed must match the original order, and the technique section should reflect the actual service provided.
- Missing supporting documentation: For instance, contrast exams may not justify the billed CPT codes unless the technique section specifies whether contrast was administered intravenously or orally.
- Inadequate detail on views/images: The number of views interpreted, not just the number of images taken, affects the selection of diagnostic codes.
- Lack of clarity: All documentation should clearly indicate what procedure was performed and why.
Modality-specific billing
Modality-specific billing is another specific area that makes it unique from other types of services. Various image modalities exist, such as X-rays, CT scans, and ultrasounds. Each one has a unique billing consideration. For example:
X-rays:
- Views Matter: The number of views (e.g., 1-view vs. 3-view chest X-ray) determines the CPT code (e.g., 71045 vs. 71047).
CT scans:
- With and Without Contrast: Different CPT codes exist for CTs with contrast, without contrast, or both (e.g., 74176, 74177, 74178 for abdominal CTs).
Ultrasounds:
- Complete vs. Limited Exams: Codes vary depending on the extent of the study (e.g., 76700 for complete abdominal US vs. 76705 for limited).
As a result of this, billing teams must understand the specific requirements for each of these modalities. Not doing so means that billing will be inaccurate.
*Disclaimer: This content is intended for informational purposes only and is not a substitute for professional coding advice.
