Interventional Radiology Coding/Billing Review

St. Clair performs, off-site with our IR coding specialist, its comprehensive IR coding/billing review because of the limited number of such records sampled, which can be provided us by over-nighting copied record excerpts or allowing access to such records via a hospital’s electronic medical record system. We review the IR procedure report, prepared by the Radiologist or Cardiologist, to determine whether all rendered services were coded and billed. St. Clair assesses how well the radiologists and cardiologists are identifying, in their dictated IR procedure reports: the vascular access site, each vessel selectively catheterized and injected with contrast and all images obtained, as well as any interventions performed, resulting complications, and remedies utilized during the IR procedure(s). In these IR case reviews, we compare the radiology and surgery CPT codes (per the procedure report) with the UB-04 billing codes in checking for missing or improper links between the radiology and surgery CPT codes. For each recommended coding change, we will note pertinent findings in the IR procedure report, as well as indicates citations from the following reference resources: Interventional Radiology Coder Users Guide (AMA/American College of Radiology), CPT Assistant, and the National Correct Coding Initiative (NCCI) & CMS regulatory standards.

A draft of the final report on the IR review findings and recommendations, with supporting documentation, will be provided within two weeks after the review. St. Clair will conduct, via a conference call, a discussion regarding the draft IR findings and recommendations. Only after obtaining your sign-off as to resolution of all hospital questions regarding the review findings and recommendations, will St. Clair issue the final report.

As a result of such an annual IR review, St. Clair is sometime requested to perform an off-site IR audit of all Medicare IR cases for the previous year, as well as an on-site IR operational assessment & IR educational in-service.

   St. Clair frequently finds IR procedure "coding change" rates of 60+%. Such changes can enable a hospital to realize $700-1,000 in incremental Medicare payments per IR case. 

   The St. Clair professional fee for an off-site IR coding/billing review is competitively priced per case reviewed.