Primer to Understanding Procedural Billing in Interventional Radiology

Monday, March 6, 2023

5:50 PM – 5:55 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Presenting Author(s)

Julia Ding, BS

Medical Student
Emory University School of Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Hanzhou (Hanssen) Li, MD

IR/DR Resident Physician
Emory University School of Medicine
JM

John T. Moon, MD

IR/DR Resident Physician
Emory University School of Medicine
TR

Thomas Renee, PA, MPH

Physician Assistant
Emory University School of Medicine
AG

Ashley Gantt, PA

Physician Assistant
Emory University School of Medicine
GW

Gail Walls, NP

Nurse Practioner
Emory University School of Medicine
Peter J. Park, MD

Assistant Professor
Emory University
Janice Newsome, MD, FSIR

Associate Professor
Emory School of Medicine
Zachary L. Bercu, MD RPVI (he/him/his)

Assistant Division Director, Innovation and Strategy; Associate Professor
Emory University School of Medicine

Disclosure(s):

Julia Ding, BS: No financial relationships to disclose

Hanzhou (Hanssen) Li, MD: No financial relationships to disclose

John T. Moon, MD: No financial relationships to disclose

Peter J. Park, MD: No financial relationships to disclose

Janice Newsome, MD, FSIR: Boston Scientific: Advisory Committee or Review Panel Member (Ongoing); CARESTREAM: Research Grant Recipient (Ongoing); Cook Inc: Consultant (Ongoing); Medtronic: Research Grant Recipient (Ongoing); TVIR: Co Editor (Ongoing)

Zachary L. Bercu, MD RPVI: Terumo Medical Corporation: Speaking and Teaching (Ongoing); XAct Robotics: Advisory Committee or Review Panel Member (Ongoing)

Learning Objectives: Review the billable components and common codes associated with an interventional radiology (IR) patient visit from initial consultation to follow-up clinic.

Background: While radiology residency provides an abundance of opportunities to improve interpretative, clinical, and procedural skills, there is a lack of education regarding the financial components to a procedural subspecialty. Even for trainees not planning to pursue a career in private practice, knowledge in procedural billing will help trainees construct well-documented notes and procedural reports that will subsequently save time from billing audits in addition to supporting sustainable practice patterns. Ultimately, it will also capture and support the value interventional radiology brings to the larger department, practice, or healthcare system at large.

Clinical Findings/Procedure Details: The learner will review the definition and purpose of Current Procedural Terminology (CPT) codes in relation to IR services {1}. The learner will review the required components for billing a consultation CPT code for an IR procedure, including a proper history, physical examination, and medical decision making {2}. We will differentiate the requirements and benefits of a consultation versus an office visit. Additionally, the learner will be able to identify the different criteria associated with each level of medical decision-making and their corresponding level of consultation CPT codes {3}. For each large category of IR procedures, we will revisit the associated global period for which no additional reimbursement can be made. Finally, we will review the post-procedural follow-up visit CPT code and when it will and will not yield in a reimbursement.

Conclusion and/or Teaching Points: Following this review, trainees will be able to better understand the financial components of an IR patient encounter from initial consultation to post-procedural clinic visit. Trainees will be better able to structure their inpatient and clinic notes to better capture the required components of a billable encounter.