Wiki MRI/MRA Coding and Billing Questions


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Hello all,

We recently opened up an IDTF (mobile MRI unit) and the billing company we have been using has dropped the ball on us completely. They have botched all our claims so bad that we are anticipating to shut down because they only have a 7% collection rate and we are struggling to stay afloat. I am seriously considering taking over the radiology billing, but I have no idea where to start! I have been doing chiropractic and pain management coding and billing for 5 years now, so I have a very solid foundation but I just don't know where to begin with radiology.

If there is anyone who can help me out or point me in the right direction, I can't begin to tell you how much it would be appreciated! I am desperate at this point and like I said, we are looking to shut down the clinic because of the poor returns the billing company we use has given us.

Thank you so much ahead of time for your help!
MRI/MRA billing questions

Are you getting pre-auth's?
Are you submitting LCD approved dx?
Are you using a 59 mod on the MRA?
Are you getting pre-auth's?
Are you submitting LCD approved dx?
Are you using a 59 mod on the MRA?

Yes get the pre auths.. but you do not just use a dx off the LCD/NCD! You must use the dx the patient has as per the documentation by the provider. If that dx is not on the LCD/NCD then obtain an ABN.
Why use a 59 modifier? If there is only one test performed this is not necessary, if the tests are bundled then what is the rationale for both, and can they be unbundled.
There are many things to consider and there is not one right answer for all issues. Look at the submitted claims, why did they not pay? that is where you begin, you must look at the past to fix the future.
I agree with Debra, and would also add when billing pay attention to combination codes, there are alot of procedures now that when performed together have a different code from the two separate codes. I know it's not an MRI but a good example of this is CT Abdomen/Pelvis. There are separate codes for those two areas, but if they are done at the same time, you would use the combo code. Just something to look out for and help you get started as well.
Also, start with claims followup. check claim status on each any every charge. It helps to learn errors and how to fix it.