let’s review the high points of each component in more detail.
Maintaining the CDM involves many components. First, it is important to verify that
all line items are present so that all existing
procedures can be appropriately charged.
Each item should be reviewed to ensure that
all CPT® and HCPCS procedure codes are
accurate and that they correspond with correct procedure descriptions and revenue
codes. The use of modifiers in the CDM
should be evaluated to ensure compliance.
Finally, a review of the pricing should
occur to ensure that each line item com-plies with the facility’s pricing policy.
Charge Process Review
If a good CDM is in place, then incorrect
coding usually occurs because of a flawed
charge capture process. A dedicated coder
can be responsible for evaluating existing
processes and suggesting/implementing
revisions to ensure all procedures are
appropriately coded and billed. If charge
capture forms are utilized in the department (electronic or manual), this individual
can revise or create forms as needed and
also educate staff about proper use of the
forms. Finally, this individual can personally perform (or create a process for performing) a daily charge audit for each section to ensure that no charges are missed.
As we are all painfully aware, there are frequent coding, compliance, and/or regulatory changes for radiology services. Any
staff members involved in the coding and
charge capture process need to receive
these updates in a timely manner. The
dedicated coder could be responsible for
training on key coding guidelines, relaying
important information that affects coding,
providing key updates on compliance
issues that impact radiology, and training
on changes to the charge process review.
It is important to remember that the
physician’s dictated report is what supports
both the physician and facility charges.
With the implementation of the Medicare
There is not one specific background that guarantees success . . .
What is important is that the candidate have an in-depth
understanding of interventional radiology techniques.
Administrative Contractors (MACs), it is
especially critical that both organizations
are billing the same procedure codes for
the provided service(s). There should be a
process in place in which the facility performs audits to review the physicians’ documentation practices and provides valid
feedback to the physicians on any discovered documentation concerns. Additionally,
there should be ongoing discussions with
the physicians to review their impact on the
charging and reimbursement processes and
any other radiology related compliance concerns (eg, supervision).
direct coding functions, a key job task that
a dedicated radiology coder could perform
is reviewing the internal edits to assign
modifiers as needed.
Ideally, the radiologist’s dictation will be
compared to the assigned procedure codes
prior to billing. The assigned codes may be
checked off on a charge ticket or assigned by
the technologist who was present during the
procedure. If the charges are not supported
by the dictation, the radiologist should be
asked to clarify/amend the report if key clinical information is missing or the assigned
codes must be corrected prior to billing. If
every case cannot be checked before billing,
periodic sampling should occur to identify
opportunities for improvement.
A designated radiology coder may
directly perform procedure coding and/or
modifier assignment or a variation thereof.
Specifically, he/she may personally assign
procedure codes for all of the interventional procedures. If that is not feasible
from a time/volume perspective, he/she
may assign codes for only the high dollar
or designated interventional procedures. If
charge tickets are utilized, the coding function may be performed by comparing the
completed ticket to the physician’s dictation to ensure accuracy. For diagnostic
procedures, this person may review the
exception report (or same day multiple
procedure report) to assign modifiers as
appropriate. Regardless of the extent of
Appropriately addressing radiology specific payor rejections and denials is an
often overlooked opportunity in many
facilities. Most business offices are focused
on inpatient accounts since they are the
higher dollar accounts. Unless there is an
abundance of staff, radiology outpatient
services rejections and denials may not be
worked, which can have a negative impact
on the department. A dedicated radiology
coder could perform any or all of the following: review rejections/denials to identify trends, review/address specific payor
issues, work specific denials to ensure
appropriate reimbursement, identify key
areas for staff education, and/or monitor
write-offs related to coding issues to ensure
accuracy. All of these items are critical to
ensure that all appropriate revenues are
captured for the radiology department.
What qualifications should you look for in
a dedicated radiology coder? There is not
one specific background that guarantees
success. A successful person could be a
technologist, hospital medical record coder,
a physician service coder, or possess a different background entirely. What is important is that the candidate have an in-depth
understanding of interventional radiology
techniques. He/she should have specialized
training in CPT® coding for interventional
procedures. You can potentially provide the
training after hiring if you feel you have
a good person for the job. This person
should have the ability to understand the
“big picture” and be very process oriented.
He/she must be highly detailed and have
the “people skills” to get results.