A radiology coding specialist must have a broad range of knowledge which would ideally include a background in coding for inpatient, outpatient, clinical, hospital, and independent radiology services. Radiology departments perform a host diagnostic and interventional procedures. Common radiology diagnostic processes include, but are not limited to, MRI, mammography, ultrasounds, MRV, fluoroscopy, lung cancer screenings, MRA, computed tomography (CT scans), and PET scans. In order to appropriately respond to needs of radiologists and radiology practices, a certified coding professional must have the level of expertise which is warranted for the benefit of the patient, the referring physician, and the radiologist.
Coding for radiology must entail a strong knowledge base in the subspecialties of abdominal imaging, emergency radiology, nuclear medicine, pediatric imaging, neuro-interventional radiology, vascular interventional radiology, musculoskeletal imaging, cardiac imaging, which includes computed tomography, MRI, CT angiography and CT pulmonary venography, thoracic imaging (chest CT, CT angiography, and conventional chest radiography), and more. Radiology is also highly influenced by bundled codes which impact reimbursement. A total of 40 new codes based on the bundling of services are anticipated for 2016. This is in addition to the 226 new codes, 129 revised codes, and the 147 deleted codes of the 2015 CPT (Current Procedural Terminology) as related to radiology.
Radiology coding requires an astute understanding of the subspecialties and services in order to assign the appropriate codes to highly complex processes. Improper assignment, incorrect bundling of codes, and “upcoding” services endangers the practice in terms of being seen as abuse or potential fraud if uncovered by an audit by the insurer. The essential demand for accurate and compliant coding is the reason that a majority of radiology practices have chosen to outsource their medical coding functions. Coding professionals ensure exceptional understanding of the latest diagnostic imaging procedures and interventional options which results in the accuracy and compliancy that only a strong team of medical coders can.