Traditionally,
Radiology Coders have had fewer opportunities to assign evaluation and management (E/M) codes than those in other specialties. There are, however, more circumstances when these codes accurately reflect the level of care provided. When service warrants reporting these codes, radiology practices are able to receive payment for time and effort over and above what is included in procedure codes. Radiologists and coders who overlook this opportunity forfeit a significant amount of reimbursement.
In most cases, E/M codes are associated with interventional, neurological and pain-control procedures. Among the services where E/M codes might be reported in addition to the procedural and radiological supervision and interpretation (RS&I) codes are percutaneous abscess drainage, angioplasty and intravascular stenting, uterine fibroid embolization, vertebroplasty and embolisms.
We are seeing more E/M codes associated with radiology in these areas, notes Jean Stoner, CPC, radiology coding specialist and manager for coding operations at CodeRyte, an Internet-enabled coding service and software provider based in Bethesda, Md. Radiologists and coders need to be aware of circumstances where assigning E/M codes is appropriate so they can collect the reimbursement to which they are entitled.
Two Key Points Validate E/M Coding
When considering whether to assign an E/M code, however, radiology coders must exercise caution. There are two key areas that can help a coder determine if an E/M code is justified, Stoner says. The first involves understanding the difference between a request for consultation and a referral from another doctor. The second entails being aware of what services are considered part of the procedural package.
When a primary-care physician or other specialist sends a patient to a radiologist, it may be considered either a referral or a request for consultation, Stoner explains. If the referring physician has already determined what procedure is to be conducted, like an injection for pain management, the patient is considered to be a referral. The radiologist performs the service and simply codes the procedure and the appropriate RS&I code.
In other cases, however, the primary-care physician may send the patient to the radiologist for a consultation requesting that the radiologist review the patients history, perform an examination, provide an assessment and recommend a plan for treatment. The radiologist may also provide the treatment, sometimes on the same day as the consultation.
This would be a time when the radiologist may report an E/M service in addition to the procedure, she says. The treatment was not planned before the radiologist sees the patient, and the referring physician isnt saying simply do this to the radiologist. The doctor isnt sure how to approach treatment and asks the radiologist for an evaluation, as well as giving approval to proceed as appropriate.
Consultation Must Be Well [...]
