Common Radiology Billing Mistakes

Medical Billing Services need to be performed keeping one golden rule in mind, “If it’s not documented, it wasn’t done!”. For radiology centres, it is always true, where accurate reimbursement depends on precise documentation and coding. If radiology billing services are not done correctly, besides the staff hours spent in reworking the claims and incorrect documentation, there will be money left on the table in the form of denials and underpayments.

Below is a list of common mistakes in the Radiology Billing Process:

1) Improper Documentation Of The Actual Number And Specific Views In A Study:

There are four different CPT codes for a knee examination, based on the number and types of views. If this is not documented properly, you may have to code to the lowest level to set things right. Not only should there be a list of the standard views for every examination, but also every action must be specified so that the medical coder can choose the right medical codes. For example, we can say that “Four views of the knee” is acceptable in terms of medical reporting. But it would be better if further details like the “AP, lateral and both obliques” are mentioned, so as to support the report. The key is the number of views.

2) Not Mentioning Essential Components In The Radiology Report:

According to the American College of Radiology, a complete Radiology Imaging Report must contain the following details:

• Name Of The Examination
• Indication/Reason for The Examination
• Exam Name, Sequences and/or Techniques
• Comparison Studies wherever needed
• Findings of the Examination
• Conclusions and Suggestions if any
• Signature of the Physician

Some other important components include mentioning if the examination was a repeat of a prior study, and the laterality wherever needed. Avoiding even one of the above-mentioned components can result in a major setback in the medical billing reimbursement process.

3) Not Distinguishing and Documenting The Scout Films:

A Scout KUB or Supine Abdomen is generally performed with an Upper GI Series to support the proper medical code, and the findings and KUB must be properly dictated from the Upper GI. Just saying “Primary Films Were Obtained” would be of no use as it would not meet the documentation requirements.

An Esophagram is bundled in the Upper GI Series, but there are cases where multiple views of the cine esophagram may be needed. If the document sufficiently supports the medical necessity for separate esophagrams, then it can be coded separately using a Modifier - 59.

4) Not Documenting All The Components Of A Complete Radiology Test:

There are strict criteria listed for what constitutes complete abdominal radiology or renal radiology, and every organ must be documented in the radiology report so as to justify the complete code in the report. If any anatomical structure is found missing from the report, you must down-code to a limited study. There should always be a permanent record and measurements for diagnostic ultrasound studies. 

5) Incomplete/Incorrect Documentation & Coding Contrast Studies:

CT scans and MRIs are considered as contrast studies, only if the contrast is administered intravenously. Oral and rectal contrast does not count as a contrast study. Besides that, the documentation must accurately reflect if the study was performed without IV contrast, with IV contrast, or without followed by with contrast. Be conscious about the coding parentheticals to look for additional coding opportunities on contrast studies which could be a best practice to implement.

6) Failing To Document The Nuclear Medicine And PET Supply Kits:

Radiopharmaceuticals cannot be included in diagnostic nuclear medicine and PET scans. But they can be billed separately by hospitals and the private imaging centres. The type and amount of radiopharmaceuticals administered must be clearly documented in the technique portion of the study before the supply codes can be added accordingly. 

Any one of these mistakes could result in denials or underpayments, which could be a heavy loss for the Radiology centre. So, it is always a better idea to outsource your medical billing services.