Radiology Coding Alert

This expert checklist gets you from reviewer to reimbursement with no fuss

Reporting unlisted procedures is more than a hassle - it requires extra time and work sometimes for a minimal payoff.

Take the hassle out of the process by following this plan for better unlisted-procedure claims, based on suggestions from Cindy Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and AAPC National Advisory Board president, during her presentation on " 'Special' Radiation Oncology Services" at the 2005 AAPC national conference in Salt Lake City.

1. Offer a detailed description of the procedure performed. Couch this in layman's terms - your reviewer may not be familiar with Radiology .

2. Include copies of articles in medical journals supporting the reasonableness of the procedure, such as clinical trials and medical indications.

3. Don't forget documentation of medical necessity to back the decision for the procedure.

4. Explain the time, effort and equipment required to perform the procedure, both to help the reviewer understand the procedure and to support the amount of reimbursement you request.

5. Remember to submit the patient's indications - diagnosis, chief complaint, presenting signs and symptoms, and any concurrent problems the patient has that require treatment or management.

6. Describe the patient's follow-up care and prognosis.

7. Relate the procedure performed to an existing procedure as support for reimbursement. (And explain how your procedure differs to show why you didn't choose the existing code.)

8. Never underestimate the power of demonstrating cost savings from the procedure you chose. If you can illustrate how your procedure will cost the payer less in the long run than the typical course of treatment, your payer should be happy to accept your unlisted procedure.