Know about the 4 Frequent Radiology Billing Challenges

Radiologists often feel overwhelmed by the intricate nature of the radiology billing process. Professional and technical components are the two things that make radiology billing complex and unique from other billing specialties. When you use apparatus, dyes & machines, you should bill it under technical components. All the diagnostic results must be billed under professional components.

Radiology billing requires precision, sound knowledge, and meticulous documentation. Unfortunately, navigating the complexities of radiology billing often becomes difficult for radiology professionals as they are not certified or properly trained for managing billing. Below are some of the common billing challenges faced by the majority of radiology centers-

Pre-authorization:

It is important to obtain prior authorization before rendering the imaging services. Payers continue to expand the list of imaging procedures that will require prior authorization. Sometimes, radiology practices perform different procedures than what was authorized. Unfortunately, when practices realize it, it is already too late to revise the authorization, thus leading to claim denials.

Non-specific diagnosis codes:

Many radiology practices still report non-specific codes. Practices must ensure that specific clinical indications are reported. For example, for an injury, instead of using a non-specific injury code, the exact type of injury or symptom should be documented and coded. Imaging reports for injuries should tell whether the exam was conducted during the initial treatment phase or healing phase or is a sequel of the last injury.

Incomplete documentation for ultrasound procedures:

You can classify ultrasounds as complete or incomplete as the CPT code descriptor indicates. If you want to bill the complete examination, you need to image and describe all the listed items and organs. You also need to document the reason if an organ is not imaged and described.

For example, when it comes to billing for CPT® 76856 Ultrasound pelvic (non-obstetric), or real-time with image documentation; you need to perform the complete evaluation and measurement of the urinary bladder, evaluation of prostate and seminal vesicles (visualized transabdominal), and any pelvic pathology (bladder tumor, enlarged prostate, free pelvic fluid, pelvic abscess).

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Missed views:

Practices often fail to capture the exact number of views. For example, in a knee exam, you dictate anteroposterior, lateral, and oblique views, and your coding team may code a three-view study. Technically, there should be both left and right oblique views. Therefore, it should be a four-view study.

These challenges often cause revenue leakage and loss of profits for many radiology centers. Fortunately, outsourcing radiology billing can come as a big rescuer for you. Outsourcing your radiology billing services enables you to focus completely on clinical care, while a perfect third-party billing team like Sunknowledge ensures a reduction of operational costs by up to 80% and a strong revenue boost.