Protect Future Reimbursement by Using Correct Specialty Designator for IR

24 November 2019 - Collaborative Imaging
Protect Reimbursement Intervention Radiology Doctor holding x-ray image of chest
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Protect your future reimbursement intervention radiology. Despite interventional radiology (IR) having its own specialty code in the Medicare Provider Enrollment, Chain and Ownership System (PECOS), the Society for Interventional Radiology (SIR) maintains that many IR groups are continuing to use code 30. Code 30 is the diagnostic radiology identifier code. In PECOS, the specialty code for interventional radiology is 94. Radiology groups that continue using code 30, instead of the Medicare IR specialty code 94, may negatively impact the reimbursement amounts. We’re talking about reimbursement amounts they receive for services provided by interventional radiologists. The new payment systems are implemented by the federal government and they require a use of new codes. These new payment systems are mandatory and were signed into law as part of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) on April 16, 2015.

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Protect Reimbursement Intervention Radiology by Using the Correct IR Specialty Designator Code and IR CPT Codes

The Radiology Coding Certification Board (RCCB) established a separate coding certification for interventional radiology procedures due to the complexities associated with IR billing and coding. This was done in 2018. Practices can greatly improve the turnaround time on their claims by using Medicare’s designated interventional radiologist specialty code 94. This can be done along with the newly revised IR CPT codes. Furthermore, by using the correct IR codes, practices can reduce the number of claim rejections and incorrect reimbursement amounts they receive due to coding errors.

Sir Offers the 2019 IR Coding Update to Assist with Transition

The Society of Interventional Radiology offers the 2019 Interventional Radiology Coding Update to assist practices as they begin transitioning to meet the new Medicare guidelines. This update is available to SIR members. Members can access the digital version of this update through their profile. Once the member enters his or her profile, the update is available under ‘digital content.’

Enrolling or Updating an IR in the Medicare Provider Enrollment, Chain and Ownership System

Any practice that is unsure whether their interventional radiologists are currently enrolled in PECOS can search Medicare’s datasets to find out. In addition, radiology practices can use Medicare’s datasets to make sure that their interventional radiologists used the correct specialty code (code 94) to enroll in the Medicare Provider Enrollment, Chain and Ownership System.

If any interventional radiologists were enrolled using the incorrect code (code 30), as opposed to the correct code (code 94), it may be beneficial to update his or her enrollment information. While updating enrollment does not impact reimbursement directly, it ensures that the services are compared to those of other interventional radiologists as opposed to diagnostic radiologists. Because the services an interventional radiologist provides and the CPT codes billed are examined by Medicare.

The Benefits of Proper Coding

To protect reimbursement intervention radiology, proper coding ensures accurate quality reporting. Thus, effectively increasing the likelihood of swift and appropriate payment for the services rendered. As such, SIR members and administrators need to work together to make sure that all a practice’s interventional radiologists’ PECOS enrollments and CMS 855I forms are coded properly with Medicare’s IR specialty code 94. Furthermore, the newly revised procedure codes must also be implemented. Hence, ensuring timely payment and the reduced number of rejected claims. Enrollment forms and easy-to-follow video tutorials are available on the Centers for Medicare and Medicaid Services’ site. To watch these videos or fill out a form, please click here.

Registration is Open for the 2020 Radiology Business Management Association’s (RBMA) Annual Meeting

Registration is now open for those who are interested in attending the RBMA’s PaRADigm event for 2020. This event will take place from April 5-8, in Hollywood, Florida, at the Diplomat Beach Resort. Those who arrive early for the PaRADigm event can take advantage of RBMA’s 2020 Coding Academy Presentation. The presentation is called: What You Should Know When Coding Diagnostic and IR Cases. This presentation will be given on April 4, 2020.