Radiology Coding Alert

Following this careful approach can mean more accurate reimbursement

If you've ever filed a claim using an unlisted-procedure code, you know it means extra work for you. Follow these tips to make sure both you and your radiologist are rewarded for your efforts.

Review your available codes carefully to make sure you didn't miss a valid code, or combination of codes, that identifies the procedure.

Review your available unlisted-procedure codes and choose the most appropriate one. If your physician performs the same unlisted procedure often, check with the carriers to see if they have a preference for a particular code and keep a file handy with all of your defenses against denial.

Prepare the documentation that must accompany the unlisted-procedure code. When you choose an unlisted-procedure code, you need to describe the procedure thoroughly to explain what was done and why the charge you set is fair. But do it in layman's terms so the claims reviewer can understand it. 
 
You should also include a reference to the code that you believe comes closest to describing what was done. This way, the insurer will be less likely to make the choice of what the equivalent should be. Chances are, the insurer could choose one that is much lower in value than what you believe is reasonable. Be sure you explain why the closest code isn't the right code and explain how the procedure that was done differed in difficulty or approach.
 
Add anything else that will justify to the insurer that the procedure was necessary and the unlisted-procedure code really is the best fit. Let the insurer know if you're bundling anything into the unlisted-procedure code.
 
Hidden resource: If you're having trouble, don't be afraid to get creative in finding help. For example, if you're using equipment that doesn't have a CPT Codes, ask the manufacturer for the best way to approach the insurer. The manufacturer wants its customers to get paid!