Radiology Coding Alert

Question: We are having trouble collecting reimbursement for the supplies that the interventional radiologist uses during office procedures. We report the appropriate HCPCS Codes , but we are always denied. Should we appeal?

Pennsylvania Subscriber

Answer: Probably not. If you perform office-based (non-hospital) interventional procedures, most insurers include payment in the procedure's fee for supplies such as biopsy needles, surgical trays, catheters, dressings, sutures, guides, scalpels and puncture sets.

Carriers normally reimburse facilities (such as hospitals or ambulatory surgical centers) directly for these costs when your radiologist performs the procedure at the facility. But even though HCPCS codes exist for many of these items (such as A4550 for a surgical tray), most insurers will not pay for the supplies separately when the physician performs the surgical procedure in an office.

The Medicare Physician Fee Schedule usually reimburses more for nonfacility (office-based) procedures than those performed in a facility. Medicare reasons that the office procedures include payment for the drugs, supplies and equipment that the physician uses during the in-office service. Because hospitals bill for these supplies independently, radiologists who perform hospital-based procedures will collect reimbursement for the professional procedure only and not the supplies.

Pennsylvania's Part B carrier, HGSAdministrators, pays about $330 for the technical service for a hospital-based tunneled catheter insertion (36557, Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; under 5 years of age). The same payer reimburses a nearly $780 global fee if the radiologist performs the catheter insertion in an office or freestanding center.