• E-mail
• Print
• PDF

Start writing: Good documentation can help reimbursement in radiology department

Radiology Administrator's Compliance and Reimbursement Insider, February 1, 2008

Break out the pens and start writing. Physicians who document what they do in the radiology department and include it with the final bill increase their chances of obtaining the most accurate reimbursement possible.

During the November 29, 2007, HCPro audioconference “Optimize Your Billing Environment: New approaches to manage your chargemaster,” William L. Malm, ND, practice director of revenue cycle management and director for the Center for Revenue Cycle Excellence at HCPro, Inc., in Marblehead, MA, and Jessica A. Little, CPC-FP, a coding and education specialist at Ohio State University Internal Medicine, LLC, division of hematology and oncology in Columbus, answered the following questions.

Q: Can the charge for the ultrasound guidance of a procedure cover the equipment and hospital charge when a physician does not dictate that hard copies were obtained? The physician’s report will mention that ultrasound guidance was used, but limits it to this statement only.

I do not bill this charge on the professional side because it does not meet the guidelines. However, can I charge for this on the facility/technical side?

A: Malm: All procedures performed and charged must have a valid order with accompanying documentation. Ultrasonic guidance, like all radiology guidance, is a packaged service this year, and therefore could not be charged by itself to Medicare. It would be best if there is some documentation in the chart to prove that the procedure was done and for what reason. The issue is one of documentation, and without supportive documentation, charges may not be assessed.

Little: I agree that this is an issue of documentation. This is a great opportunity to increase a physician’s revenue without changing the services they perform by simply changing how they document.

In order to do that, physicians need to be educated about what documentation is required to bill for this code. Permanent records of ultrasound examinations, such as description of anatomic region, measurements, obstructed view, and site to be localized for a guided surgical procedure, are required.

A written report of the exam should be included in the patient’s medical record. Do not report an ultrasound without a thorough examination of the organ(s) or anatomic region, documentation of the image, and a final written report.

As far as the facility charge goes, this is a bundled/packaged charge for this year for ambulatory surgical center–covered surgical procedures, so it could not be billed in addition to the procedure that was performed.

0361 versus 0761

Editor’s note: During the November 29 audioconference, a question was asked by one of the listeners about the difference between revenue codes 0361 and 0761 in interventional radiology.

Q: You said to go with 0761 over 0361. Is this true only for the radiology codes and not the surgical procedure codes that are in addition to the radiology code ( i.e., 61624 Embolization, and 75894 and 75898 radiology portion of procedure 47000 Core liver biopsy and 76942) ultrasound guidance? As far as reimbursement goes, what effect will 0361 play in payment versus 0761?

A: Malm: The answer here is divergent. The example of 61624 poses special concerns as this is (for 2007) an “inpatient procedure only” C status indicator for outpatient prospective payment system (OPPS). 

Therefore, if performed on an outpatient, it will not be reimbursed at all. For this procedure to be a properly admitted inpatient, the revenue code would be inpatient surgery, or 0360.

However, for non–C status indicators or those services that can be performed and billed as outpatients under OPPS, the most appropriate revenue code is used to reflect the area in which the costs were accumulated. Because this is clearly not the OR, then 0361 would not be your most appropriate, and 0761(by default) could be considered. Additionally, other payers may require that 0761 be used instead of 0361. Your reimbursement is based on HCPCS codes for OPPS and contractually by your non-Medicare payers. Use the revenue code that they specify.

Insider sources

William L. Malm ND, practice director, revenue cycle management, and director for the Center for Revenue Cycle Excellence, HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945, 877/233-8734, 440/376-5978 (mobile); wmalm@hcpro.com.

Jessica A. Little, CPC-FP, coding and education specialist at Ohio State University Internal Medicine, LLC, division of hematology and oncology, Columbus, OH, 614/619-6073; jessicalittle5@hotmail.com.

• E-mail to a Colleague
• Print