to school to become medical coders so it
is important we do not ask them to be
coding experts unless we provide adequate and complete training. Additionally, there is the challenge referenced
above of physician documentation.
Unless the technologist knows exactly
what the physician will be documenting,
there is a great risk that there will be a
mismatch between what was charged for
the facility and what is described in the
dictated report. It is critical you evaluate
processes to ensure you are not missing
charges and/or overcharging for services.
If technologists are responsible for charge
capture, I hope that at a minimum they
are conferring with the interventionalists
after each case to discuss what the physician will be documenting. I have been at
facilities where the physicians and the
technologists do not even speak to one
another—this is not a functional environment.
Questions to consider:
• Who is capturing the charges for inter-
Mismatches between the
RIS and CDM
Depending on how charges flow through
your systems, the mapping between the
RIS and CDM may be critical for correct
charge capture. If technologists are selecting charges in the RIS, which then maps
over to the CDM, it is very important
these files be compared on a frequent basis
to ensure both are up-to-date and accurate. Many times, I find that someone in
the finance department will update the
CDM and a different person will update
the RIS and there is not always a quality
assurance check between the two. When
that happens, charges are missed, incorrect charges are passed through the system, and/or overcharging can occur.
Specific areas to evaluate:
• Are you utilizing your RIS in the charge
The assignment of modifiers is arguably
just as important as the initial assignment of a procedure code to represent
the performed service. The responsibility
for assigning modifiers varies significantly by organization; however, it is
critical that radiology administrators
know who is doing it and on what information they are basing their decisions to
apply or not apply modifiers. I have seen
many radiology departments lose money
because someone outside the department chose not to apply a modifier and
allow billing for an appropriate service.
There should be a clear line of communication between the individuals capturing the charges and the individuals
responsible for assigning modifiers. You
can create a list of the most frequently
encountered scenarios so that communication is not required for every scenario.
Things that fall outside the list should be
discussed so there is open communication and the potential to identify opportunities for education either with radiology staff or the individuals assigning the
• Who is responsible for assigning modi-
fiers for radiology services?
It is important that an order exist for all
diagnostic radiology services. There are a
variety of rules as to what can and cannot
be done depending on the payor, but the
bottom line is that in an audit the payor
wants to see a copy of the order requesting
the performed service. If you have added or
changed anything from the original order,
the payor wants to know why and they usually ask for their money back. This is an
area where there is a great deal of frustration that occurs for the patient as well as the
facility. Regardless of this fact, it is imperative you make sure you have the order for
the service and that you can retrieve the
order upon request. I have been to facilities
where the orders were randomly filed in
boxes and placed in an out of service treatment room. I surely hope they never get
audited because it would cost a fortune to
find the specific orders.
Things to consider:
• Do you ensure you have orders for all
Every organization and facility has issues
they need to address. No place is perfect.
It is important to be aware of these issues
so you can not only fix them but provide
appropriate monitoring on an ongoing
basis to ensure consistent compliance. All
of the issues described here are “big”
issues to address, but don’t lose heart.
Positive change is usually accomplished in
incremental steps so take it one step at a
time and celebrate your progress!
Melody W. Mulaik is president and co-founder of
Coding Strategies, Inc. She is a nationally recognized
speaker and has delivered numerous presentations at
AHRA annual meetings and conferences. Melody is a
member of AHRA, has published extensively, and may
be contacted at email@example.com.