Practice Development

Session: Educational Exhibit Presentations - Station 10: Pediatric Interventions/Portal Hypertension/Practice Development

Achieving Competence in Evaluation & Management Billing in the Outpatient Setting

Monday, March 6, 2023

5:30 PM – 5:35 PM

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

Abstract Presenter(s)

Jung H. Yun, MD

Integrated IR/DR Resident Physician
Einstein Medical Center, Jefferson Health

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

NR

Nicholas Roberts, DO

Diagnostic Radiology Resident Physician
Einstein Medical Center, Jefferson Health
Isael Perez, Jr., MD

Independent IR Resident Physician
Einstein Medical Center - Thomas Jefferson
Akash Desai, MD

Integrated Resident
Einstein Health Care Network
AA

Alexander Anavim, MD

Integrated IR/DR Resident Physician
Einstein Medical Center, Jefferson Health
SD

Sagar Desai, DO

IR/DR Resident
Einstein Medical Center
SL

Shiyi Li, MD

Integrated IR/DR Resident Physician
Einstein Medical Center, Jefferson Health
BN

Bala Natarajan, MD

Attending Interventional Radiologist
Einstein Medical Center, Jefferson Health
MC

Matthew Callaghan, MD

Attending Interventional Radiologist
Einstein Medical Center, Jefferson Health

Disclosure(s):

Jung H. Yun, MD: No financial relationships to disclose

Akash Desai, MD: No financial relationships to disclose

Alexander Anavim, MD: No financial relationships to disclose

Shiyi Li, MD: No financial relationships to disclose

Learning Objectives:

Highlight the importance of evaluation and management (E&M) billing to the growth of interventional radiology (IR)

Understand the different work relative value units (RVUs) associated with each code

Demonstrate how Interventional Radiologists can utilize different levels of code to capture time spent or provide detailed documentation for each clinical encounter

Maximize work RVUs for work already being done by accurately reflecting the service provided

Background: As health care evolves, medical specialties providing patient‐facing services are increasingly more valued, with policymakers using E&M billing to determine our value. Over the past decade, IR has become a more clinical service with pre- and post-procedural care in both inpatient and outpatient settings. Outstanding patient care demands clinical excellence, and due to the complexity of medical decision-making in IR, E&M services and documentation are critical and medically necessary. Interventional Radiologists must understand how to accurately bill for the services provided to maximize revenue, promote our specialty’s growth, and optimize patient care.

Clinical Findings/Procedure Details: The IR department at our institution generated 4,213 RVUs for E&M in the 2022 fiscal year. We will focus on E&M billing for outpatient/televisit RVUs for this exhibit. An outpatient clinical encounter may be categorized as one of two options: consultation or office visit, and either as a new patient or established patient. A consultation, a service requested by another physician for an opinion on the E&M of a specific problem, requires documentation in the electronic medical record and written communication to the requesting physician, and thus, generally carries higher reimbursement than office visit codes. However, only office visit codes are eligible for Medicare billing. Encounter codes are billed based on the time spent or on the aggregate of points associated with specific components of documentation, which we will summarize in this exhibit. Additionally, we will provide data from our institution to demonstrate the RVUs associated with each code and the total RVUs generated in 2022.

Conclusion and/or Teaching Points: As IR becomes a more clinical service, outpatient clinical encounters have become a necessary component of pre- and post-procedural care. E&M billing is an important skill for the Interventional Radiologist to maximize departmental revenue, increase the value of our specialty, and optimize patient care. This exhibit will provide examples of outpatient/televisit clinical encounters and walk the learner on how to appropriately bill for each encounter.