Radiology Billing Guidelines:

Ø  A complete radiology report is essential to support proper code assignment and optimal reimbursement, and should include, minimally, the following elements: (patient name, dob, age, sex, Referring Physician, date and Time of the study, Patient history, Reason for the study)

Ø  The diagnosis cited must support medical necessity for the study. Check with individual payers and applicable local or national coverage decisions for a list of acceptable diagnoses and documentation requirements by study type.

Ø  Specific administered activities, concentration, volume, and route of administration (e.g., intravascularly

Ø  +, intra-articularly, or intrathecally), when applicable; and medications, catheters, or devices used, if not recorded elsewhere, should also be documented.

Radiology Documentation Guidelines:

Ø  Documentation needs to be concise and clear, using language that is close to the CPT descriptors for valid related codes

Ø  Indications should be documented separately from findings and impressions

Ø  Exam titles need to have the elements for correct assignment and should include modality, views, anatomical site, and whether any contrast was used. 

Professional and Technical Components:

Ø  Most radiology procedures include both a technical component and a professional component

Ø  The technical component (TC) of a service includes the provision of all equipment, supplies, personnel, and costs related to the performance of the exam.

Ø  The professional component of a service includes the physician work in providing a dictated report or dictated report and supervision. To report only the physician work portion of a service, append modifier 26 Professional component

Ø  A global service occurs when the physician both bears the expense of equipment supplies, etc., and provides supervision and/or prepares the report. Global services generally take place in an office setting, where the physician group owns the equipment and provides the dictated reports. When reporting global services, modifiers TC and 26 are not required.

2019 Changes for Radiology:

Knee Arthrography: For the injection of contrast for knee arthrography was noted as a potentially mis valued service. It’s often been incorrectly reported as aspiration or arthrocentesis, and it’s up for deletion this year.

Modifiers:

• 26, professional component:When a radiologist is only interpreting films or imaging/tracing and is not providing the machinery, this modifier should be added to the code on the claim form. Typically, this occurs when a radiologist is reviewing for a hospital, an ambulatory surgery center (ASC), or a doctor’s office that owns the equipment and provides the staff but requires the radiologist to interpret the images and write reports.
• TC, technical component:This modifier covers the expense of the staff, machinery, equipment, and nonprofessional interpretation elements required to provide a radiological film or image/tracing. Oftentimes, a hospital, ASC, or office will use this modifier when submitting a claim for a radiological service performed.

76, repeat procedure, same physician: When a procedure or service must be performed again on the same date of service by the same physician (regardless of the outcome), this modifier should be included with the CPT code on the CMS-1500 form.

• 77, repeat procedure, different physician: This modifier should be included with the CPT code for the same scenario involving modifier 76 but when a different physician performs the repeat procedure. (Note: Medicare considers all physicians in the same group practice with the same specialty to be the same physician.)
• LT/RT, left side/right side: Depending on the side of the body that is imaged, one of these modifiers is be appended to the code to reflect only one side was imaged.
• 50, bilateral procedure: This modifier relates to circumstances in which both sides of the body are imaged or a procedure is performed on both sides of the body. Do not use this modifier if the code is written as a bilateral procedure or service, as it is expected to be performed on both sides. Also, “both sides” does not mean front and back (AP/PA and lateral); it refers to right and left sides.

50 Modifier Vs RT/LT:

some payers may not acknowledge modifier 50 to reflect bilateral sides. If this is the case, two-line items will be reported: one with modifier LT and one with modifier RT. Modifier 50 is typically used more often than modifier LT/RT; however, payers generally dictate how these get used. Contact your payers, Medicare administrative contractors (MACs) and Medicaid integrity contractors (MICs) to ensure what they expect, as some MACs and MICs will not take modifier 50 under any circumstance, while others won’t take LT/RT