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Radiology Coding Alert

Communication With Three Key Players Brings Reward

Published on Mon Oct 01, 2001

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 coders. Coders unsure about which images were obtained and, therefore, what codes may be reported should seek the specialists input. The radiologist can clarify what is contained in the report and indicate how the clinical terms relate to coding definitions.
 
Many radiology practices have adopted a Standard for Communication developed by the American College of Radiology (ACR). While the Standard primarily presents guidelines for communication with the referring physician, it also assists coders because it encourages the radiologist to include a description of the study and the procedures and supplies used, along with an explanation of clinical issues and limitations.
 
The Patient. Payment depends also on clear communication with the patient -- particularly when the insurer may not pay for the x-rays ordered. Admitting that this can be a delicate process, Lane notes that being up-front with patients is vital. When a practice knows that there is a chance the x-rays might not be covered, its wise to let the patient know ahead of time. Medicare patients, she adds, should be asked to sign an advance beneficiary notice (ABN).
 
Often, front-desk personnel at a radiology practice misunderstand when a patient needs to sign an ABN. These waivers should be signed only when the x-rays ordered might be covered by Medicare in some instances, but not covered under the current circumstances. In some cases, the patients condition or history might support the local Medicare carriers standard of medical necessity for the service. In other situations the x-ray would not be covered.
 
CMS recently revised the ABN form that practices should use with Medicare patients. More information on the form is at www.codinginstitute.com/news/article9.html.

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