Interventional Radiology Coding/Billing Review

Process

A St. Clair Senior Consultant, with IR coding skills, performs, off-site its comprehensive IR coding/billing review for an appropriate sample of cases.  The consultant reviews the IR procedure report, prepared by the Radiologist or Cardiologist, to determine whether all rendered services were coded and billed appropriately.  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.

In the course of performing the review, St. Clair drafts a “case by case” Excel spreadsheet regarding its findings and a draft narrative report which are forwarded for client review prior to an exit conference call.  After obtaining client sign-off as to resolution of all hospital questions regarding the review findings and recommendations, St. Clair issues the final report.

Benefits

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.

Pricing Approach

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