Radiology Claims Continue to Rise

Radiology claims are on the rise and there are two types distinct types of radiology claims, evaluation and management. Both are valid reasons for radiology and both need to be reimbursed, however you need to make sure that your documentation backs up the coding that is used in your medical billing claim.

Radiologists can perform several types of services. One of these services is an evaluation and management session. When doing medical billing for a radiologist it is important to make sure a session meets three categories before coding it as evaluation and management session. The three categories are: request, render, and report.

The first necessary element for a radiologist E/M visit is a formal request by a physician for an opinion. This must be documented in the medical billing medical record that the referring physician would like the opinion of a radiologist before making a medical decision.

The next element that must be present when medically billing for an E/M radiology visit is rendering. This means, the radiologist must perform a real exam or review of the patient. It must be thoroughly documented. For example, all topics discussed with the patient should be listed with the amount of time spent on each topic. The amount of time spent on the entire exam should be clearly stated with the minutes broken down so that anyone would understand. This insures more accurate medical billing.

Last but not least, a report from the radiologist to the referring physician is required. This can be stated in the medical records as long as it is clear what the findings are.

View all Articles by: Melissa Clark, CCS-P