Assigning the proper codes for x-rays obtained in an outpatient setting and ultimately being paid for these services depends in large part on good communication -- with ordering physicians, with radiologists and with the patients themselves.
The Ordering Physician. When coders arent sure about which code to report, they need to go back to the original orders, says Linda Lane, CPC, director of patient accounts for University Radiology Associates of Cincinnati Inc., in Ohio. The claim must reflect the views that the referring physician requested.
One of the biggest challenges we face is getting enough information from ordering physicians to assign codes that will get paid, she says. Even when they are clear about what images need to be obtained, the physicians sometimes dont give us enough diagnostic information to support the claim. For instance, when they order studies to rule out conditions, they may not understand that this information is not enough to get paid. Instead, the orders need to explain clearly the signs and symptoms that necessitate the test. It also helps if the physician tells us what to look for, like a fracture, she adds.
When this type of information is missing, Lane says, it pays for a
Radiology practice to be diligent about contacting the ordering physician. This can be done at two points in the process:
If the radiology technologist feels the orders are unclear, a call to the attending physician can immediately be placed while the patient is in the suite and the orders amended before the films are taken. This conversation must be documented in the medical record.
If the orders clearly indicate which images need to be obtained, but lack vital diagnostic information, the call to the ordering physician can be made after the x-rays have been completed, but before the charges are submitted.
In the second situation, its important to notify the physician that you have seen the patient, but that you dont have enough information to bill the x-rays, Lane says. A lot of times, its a matter of education. The ordering physician may not be aware of the type of information a radiologist needs to successfully bill an x-ray. She adds that her practice has trained its coding and billing staff to intercept radiology reports that lack necessary information, and make these calls before submitting the claim.
Editors note: At the time this issue of Radiology Coding Alert went to press, a clarification from CMS on physician ordering rules was imminent. Radiologists were expecting that CMS would relax restrictions (e.g., allowing them to obtain additional views when indicated). Visit
www.codinginstitute.com/news/article12.html for updated information about CMS changes.
The Radiologist. Similarly, radiologists within the practice are a great resource to [...]
