Tim Myers, MD, is a practicing radiologist and director of professional services at vRad (Virtual Radiologic). He has more than 15 years of private practice experience and served as the chief medical officer for NightHawk Radiology Services before its merger with vRad.
I don't think it's possible to read a newspaper or journal that has to do with medicine that doesn't also include information about reimbursements being cut. Business managers are doing everything possible to improve billing.
So, why do many radiologists and practices still make easily correctable mistakes? The answer: I have no idea, except to say that it takes some of us a while to develop different patterns of thinking and then dictating.
Becoming familiar with the CPT code and the ICD-9/ICD-10 coding is important for proper performance of the examination and proper billing. Following standards of care which have been delineated within the medical literature is also important.
I would not recommend performing an examination or a specific component of an examination just for billing. Remember, we want to appropriately scan the patient, appropriately evaluate all the structures necessary to treat that patient and then discuss those specific elements within the examination. If, by medical determination a limited study is adequate to treat the patient, perform a limited study.
Here are the first five of 10 common mistakes and how to correct them. Stay tuned next week for the next five correctable mistakes.
1. CT angiography of the chest: The most common mistake is first to only do multiplanar/MPR reconstructions of the chest and not MIP/3-D reconstructions. Most imaging protocols across the country now provide for MIP/3-D reconstructions. I believe this has now become standard of care for these studies, so if you are not currently doing them you should consider correcting the protocols you use. Once you have changed the protocol to include these, or if you already do them, you need to make sure that in your dictation, the 3D/MIP reconstructions are discussed.
2. Abdominal ultrasound: Please note that anything less than a complete study is a limited study. Even if one element is missing, it is a limited study. If it is not billed as a limited study, this can have potentially serious consequences. Enough said. For a complete abdominal ultrasound, the usual suspects have to be mentioned including the liver, gallbladder, common duct, pancreas, spleen and kidneys. If a structure is attempted to be visualized, for example the pancreas, but is not seen, mentioning that fact is adequate. The most common mistake? Not mentioning the abdominal aorta and inferior vena cava. Not mentioning these changes a completely imaged study to an incompletely dictated study and billing as a limited study.
3. MRCP: Most protocols include MIP/3-D reconstructions. Some don't. This, like the 3-D reconstructions for the CTA chest, is typically considered standard of care and if you are not currently doing them, you should consider changing protocols. Once done, the fact that MIP/3-D reconstructions were obtained should be discussed. Additionally, if these are performed at a separate workstation versus on the MR scanner itself, that should be mentioned as well.
4. Including contrast and route of administration: Many times radiologists just dictate that contrast was administered or that this is an examination with contrast. Not mentioning the route of administration, in this case the important descriptor is intravenous or IV, should lead to a down coding to a noncontrast study.
5. Renal/retroperitoneal ultrasound: We typically think of a renal/retroperitoneal ultrasound as having to do with the kidneys and perinephric spaces. A complete study, in the billing sense, also requires that we perform and then discuss an evaluation of the bladder. This is especially necessary if the clinical history has to do with urinary tract pathology.
Have a mistake to add to the list? Tell us about it in the comments below.