Radiology Coding Alert

As with many advances in todays age of technology, the technological potential of teleradiology is outpacing the development of clear coding and adequate reimbursement policies.

The main challenge faced by professional coders is that there is no Teleradiology section in the CPT Codes . This is compounded by the fact that the technology is being used in a number of ways, each of which may pose unique reimbursement riddles:

In some instances, radiologists use teleradiology to provide consultative servicesand codes appropriate to those services may be assigned.

In other situations, the use of teleradiology may not be recognized at all and payment may be denied.
In still other cases, radiologists are using the technology to provide primary interpretations, and these situations are coded in the traditional manner (see box on page 22).

Determine Situations Where Teleradiology is Billable

Briefly, teleradiology is the process of digitizing an x-ray image and transmitting it via computer to a remote location where it can be viewed. Films are transferred quickly and easily, with great visual resolution, making it possible for physicians and radiologists to have convenient access to images.

The following scenarios illustrate cases where teleradiology is being usedand what coding alternatives
might be used to maximize reimbursement.

Scenario 1Reimbursement unlikely.: A radiologist in a large academic setting is interpreting films taken of a young woman patient with a suspicious uterine mass. She wants a colleagues input and transmits the images digitally to his office down the hall, asking her associate for his opinion.

In this, its simplest application, teleradiology most likely would not be reimbursed. This example is no different than a hallway conversation, where you grab a colleagues sleeve and ask his or her opinion, says Susan Callaway-Stradley, CPC, CCSP, an independent coding consultant in North Augusta, SC. The second radiologists reading isnt billable. In this instance, you must look at teleradiology merely as a convenience. Instead of having to pick up the films and carry them down the hall, the second radiologist can look at them on his computer.

The second radiologists involvement is not considered a consultation because it doesnt exhibit the three characteristics required for that category of service: 1) There must be a written request from the first radiologist for an opinion; 2) there must be a written response sent from the second radiologist to the first; and 3) the consultants opinion must be documented in the patients medical record and communicated to the requesting physician or other appropriate source.

Scenario 2: Billable as a consultation. A Radiology Practice in rural Oklahoma is viewing films of a patient with a rare gastrointestinal disorder. The group contacts another practice in Oklahoma City, knowing they have had greater experience with this condition, and transmits film for [...]