E&M Billing for Interventional Radiology - PowerPoint PPT Presentation

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E&M Billing for Interventional Radiology


A radiology practice that includes interventional procedures has to be up to date on the use of documentation and coding techniques for Evaluation and Management (E&M) services.  – PowerPoint PPT presentation

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Title: E&M Billing for Interventional Radiology

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EM Billing for Interventional Radiology
A radiology practice that includes interventional
procedures has to be up to date on the use of
documentation and coding techniques for
Evaluation and Management (EM) services. Since
these CPT codes in the 99xxx range are less
commonly utilized in many radiology practices,
identifying circumstances where EM services are
billable, and then properly documenting and
coding for them, will require a collaborative
effort between interventional radiologists (IR)
and their coding team. A patients visit with
the IR prior to a procedure can variously be
considered a consultation, an office visit, or a
non-billable component part of the procedure
depending on the circumstances. The first step is
to determine if a visit is separately billable
and then if it is, what are the proper
documentation and coding requirements. Check if
the Service is Separately Billable The initial
visit might be considered by Medicare and other
payers to be a component part of the surgical
procedure. The rules that define payment for EM
services use a concept called the Global Surgery
Package. The global period (GP) begins on the day
of the procedure (or on a preceding day in the
case of a 90-day GP) and, depending on the CPT
code for the procedure, could run for 0, 10, or
90 days following the procedure.
EM Billing for Interventional Radiology
Generally, EM visits for the purpose of deciding
whether or not to perform a procedure are
billable and payable if they occur outside of the
GP. During the GP, all services related to the
procedure are included as a component part of the
surgical package and therefore are not separately
reimbursable. However, for a procedure with a
90-day GP, considered to be a major surgery, an
EM service performed on the same day or
preceding day for the purpose of deciding whether
to perform the procedure may be separately
reported and payable with the addition of
Modifier-57 (Decision for Surgery). In the IR
clinic, scheduling the patients initial visit
with the physician at a time distinctly separate
from the procedure itself will allow the billing
of EM codes in addition to the coding for the
procedure. Thus, for a 0- or 10-day GP procedure,
the initial visit should be no later than the day
prior to the procedure and for a 90-day GP
procedure, it should be at least two days prior
to the scheduled procedure unless it fits into
the exception described above. Otherwise, a
consultation on the same day as the procedure or
on the day preceding the procedure will usually
not be separately billable. Check the Level of
EM Billing for Interventional Radiology
When an EM visit is separately billable,
determining the level of coding depends first on
where the service takes place. Beginning in 2021,
hospital outpatient and office procedures will be
determined either by the level of medical
decision-making or by the total time spent on the
patients case on the date of service. Prior to
2021, the level of service was determined by
using a seven-level evaluation of components, but
today the system is much simpler. Note that the
rules for hospital inpatient and emergency
department services have not yet changed. The
following table outlines the current criteria for
each level of outpatient coding    
Level of Medical Decision Making New Patient New Patient Existing Patient Existing Patient
Level of Medical Decision Making Total Time Spent Code Total Time Spent Code
Minimal N/A 99211
Straightforward 15 29 minutes 99202 10 19 minutes 99212
Low 30 44 minutes 99203 20 29 minutes 99213
Moderate 45 59 minutes 99204 30 39 minutes 99214
High 60 74 minutes 99205 40 54 minutes 99215
EM Billing for Interventional Radiology
Consultations vs. Office Visits A visit with the
IR to determine the propriety of an
interventional procedure is often referred to as
a consultation, but the term has a very
specific definition and set of requirements in
the context of coding and billing. A
consultation is defined as a service that
Requires an opinion or advice regarding the
evaluation and management of a specific problem
and Is requested by another physician or other
appropriate source. A consultation initiated by a
patient or family member, but not requested by a
physician, may not be reported using consultation
codes but rather will be reported using the
office visit codes.   When they are available for
use, consultation codes in the range 99241-99245
normally carry a higher reimbursement than office
visit codes for the same level of service, but
they also require some additional work. The
request for consultation, the consultants
opinion, and any services that are ordered or
performed must all be documented in the patients
medical record and communicated by a written
report to the requesting physician. Consultation
codes are not recognized by Medicare or by
certain other payers such as United Healthcare.
EM Billing for Interventional Radiology
For those payers, the appropriate regular office
visit codes are used even if the tasks of
additional documentation and sending a separate
written report are performed. Note, however, that
under the new time-based rules for EM visits the
time to document and create a separate report is
added to the overall visit time and perhaps this
could lead to a higher level of coding and
reimbursement. EM billing for
interventional radiology requires medical
billing experts who have a good understanding of
payer-specific reimbursement policies and billing
guidelines. Finding and retaining such medical
billing experts could be a challenging task. In
such cases, you can outsource your medical
billing and coding functions to Medical Billers
and Coders (MBC).   Our interventional radiology
billing services include charge entry, payment
posting, denial management, IR coding, accounts
receivables, provider enrollment, and
credentialing. To know more about interventional
radiology billing and coding services, contact us
at info_at_medicalbillersandcoders.com/ 888-357-3226.
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