The radiology market size was valued at 144.48 billion USD in 2023 and is expected to grow at a CAGR of 4.25% from 2024 to 2030. The increasing prevalence of cancer and cardiac disorders coupled with growing awareness about imaging services in diagnosis, are the major contributing factors. However, with the evolving technology, clinical and administrative protocols are changing. This increases the complexities and challenges in radiology billing and coding. As a result, several radiology practices are not experiencing accurate revenue growth and operational stability.  

In this brief guide, we discussed different nuances of radiology billing services, that might help you maintain the functional and financial integrity of your practice.

Most of the radiology services consist of professional and technical billing. Professional billing refers to services provided by the radiologist, including supervision during imaging, interpretation of the images, and writing reports. The technical component includes equipment, procedures performed, supplies, and other costs related to the procedure or examination. 

To ensure accurate reimbursements, you must understand the coding requirements and payor guidelines for claim submission. Not only the ICD-10 codes, but you must implement accurate CPT and HCPCS codes within the billing process for correct reimbursements. 

Here are some of the CPT codes for radiology services-  

• Diagnostic Ultrasound: 76500—76999   
• Radiologic Guidance: 77001—77032   
• Breast, Mammography: 77051—77059   
• Bone/Joint Studies: 77071—77084   
• Radiation Oncology: 77261—77999  

Interventional radiologists, who use imaging technology to conduct minimally invasive procedures, can have different billing concerns than those of traditional radiologists. Some of the medical codes fall under the surgical CPT codes, as opposed to the diagnostic codes used by traditional radiologists. Therefore, interventional radiologists must know both the diagnostic and surgical codes to get correct reimbursements.

Here are a few examples:  

• Mechanical Thrombectomy: 34201, 34421, 34490   
• Biliary Drainage: 47510, 47511, 47530   
• Cholecystostomy Tube Placement: 47490   
• IVC Filter Placement: 37620   
• Biliary Stone Removal: 47630   

1. Patient Intake  
2. Eligibility verification and prior authorization  
3. Medical coding and documentation  
4. Claim submission  
5. Denial management  
6. Payment   
7. Data reporting  

Many of the challenges in radiology billing stem from the misassignment of codes, which can lead you to claim denials and revenue loss. Some of the challenges have been discussed here-  

You must use accurate modifiers to distinguish between technical and professional components of the rendered services.   

For instance, the CPT code 76700 denotes an abdominal ultrasound. To get the accurate professional reimbursement for the service you need to bill it as 76700-26. The 26 modifier indicates a professional component of a service or procedure and is generally billed by the physician.   

If the same ultrasound scan is performed in a hospital or imaging center, the facility would bill TC along with this to indicate the technical portion of the service.   

Radiology billing is susceptible to under coding, or billing for a service that is less complex than the actual procedure performed. This can result in lower reimbursement rates and can shake your practice’s financial and functional stability.  

It happens when you bill for a service or procedure that is higher in complexity compared to the actual procedure performed. It is a serious violation of medical billing regulations that can jeopardize your reputation, the practice’s integrity, and patient trust. You must be extremely careful when billing for any services performed. 

Advancements in technology and ever-evolving guidelines are constant in the realm of healthcare. To combat the radiology billing challenges here are some of the strategies that you can consider-  

Before providing any services, it is necessary to check the patient’s insurance eligibility and benefits. Not only for the new patients, but you must also consider eligibility verification in case of a patient revisit.  

Missing information in the document can deflate the revenue. Lack of patient information, medical history, and proof of medical necessity along with the procedures performed should be well-documented to obtain correct reimbursements. Also, keep track of the diagnosis codes, CPT codes, HCPCS codes, and modifiers. It is important to have a system organizing this information while ensuring data accessibility and availability.  

Submitting claims under the payor deadline can save you from payment delays and inaccurate reimbursements. It's all too simple for payments to go between the cracks because of the constant stream of new cases and the disparate deadlines set by different insurance carriers.  

To eliminate the billing challenges, you need to stay abreast of coding and billing guidelines. Conduct regular training processes for your staff so that they understand and develop the skill set to handle your administrative tasks. Also, you can consider regular internal audits to identify the loopholes within the billing process. This way you will be able to make informed decisions while setting targeted areas that need training.  

Gaining proficiency in radiology billing necessitates a thorough comprehension of all the nuances involved as well as a dedication to continuous growth. You may assure appropriate reimbursement for your radiological services, optimize revenue cycle efficiency, and expedite your medical billing process by putting the ideas described in this brief guide into practice. To keep ahead of the always-changing medical billing scene, embrace technology, encourage teamwork, and stay current with industry changes.