Interventional radiology practices must master the nuances of E/M service billing

Practices that provide interventional radiology care must master the nuances of billing for evaluation and management services, one expert stressed on Thursday.

Under new 2021 rules, CMS will determine hospital outpatient and office procedure payment based on the level of medical decision-making or the total time spent on the date of service. Before this year, the process was much more complicated, Healthcare Administrative Partners noted Friday.

“It is imperative that the radiologist’s coding team be familiar with the rules and regulations surrounding the billing of E/M codes,” wrote Erin Stephens, senior client manager, education, with the Media, Pennsylvania-based consulting firm. “The practice should be sure their coders routinely receive the consultation or office visit reports in order to properly determine the correct billing, preferably via the usual billing interface.”

Such CPT codes are not commonly utilized in most imaging practices and identifying the scenarios where E/M services are billable will require collaboration between interventional radiologists and coders. Typically, a patient’s visit with an IR before a procedure can be classified as a consultation, office visit or nonbillable component, Stephens noted. She said the first step is determining if the visit is separately billable, and then working through the particulars.

“Understanding the nuances of evaluation and management service billing will allow the IR practice to set up its scheduling, documentation and reporting systems in a way that optimizes their ability to maximize the revenue from patient interactions surrounding interventional procedures,” Stephens concluded.

You can read more of her advice in the HAP Radiology Billing and Coding Blog below