Skip to content 
Interventional Radiology (IR) is an advanced field that uses minimally invasive techniques guided by imaging technology like CT scans, MRI, ultrasound, and fluoroscopy to treat and diagnose a variety of conditions. Accurate coding for IR procedures is crucial for proper billing, ensuring that healthcare providers are reimbursed for their services while maintaining compliance with regulatory guidelines.
Key Considerations in IR Coding
There are several key aspects that IR coders need to focus on:
- CPT Coding: Correctly identifying and assigning the right CPT codes for IR procedures.
- ICD-10: Accurately applying ICD-10 codes to represent diagnoses.
- Modifiers: Properly applying CPT modifiers to reflect the complexity and specifics of the procedures.
- Documentation: Ensuring complete and accurate documentation for every IR procedure.
Common CPT Codes for Radiology
Below is a table with extracted CPT codes related to various radiology procedures commonly used in IR:
| Body Part/Procedure | CPT Code |
|---|---|
| Neck Soft Tissue | 70360 |
| Pharynx | 74210 |
| Lumbosacral Spine (Bending Only, 2-3 VWS) | 72120 |
| Pelvis (Complete, Min. 3 VWS) | 72190 |
| Pelvis (Limited, 1-2 VWS) | 72170 |
| Lumbosacral Spine (6 VWS with Bending) | 72114 |
| Lumbosacral Spine (4 VWS) | 72110 |
| Sternum (Min. 2 VWS) | 71120 |
| Lumbosacral Spine (2-3 VWS) | 72100 |
| Ribs Bilateral (Including PA Chest, Min. 4 VWS) | 71111 |
| Ribs Bilateral (3 VWS) | 71110 |
| Unilateral Ribs with PA Chest (Min. 3 VWS) | 71101 |
| TMJ (Unilateral, Open and Closed) | 70328 |
| TMJ (Bilateral) | 70330 |
| Ribs Unilateral (2 VWS) | 71100 |
| Skull (Complete, Min. 4 VWS) | 70260 |
| Skull (Limited, 1-3 VWS) | 70250 |
| Sinuses/Paranasal (Complete, Min. 3 VWS) | 70220 |
| Sinuses/Paranasal (Limited, 1-2 VWS) | 70210 |
| Orbits (Min. 4 VWS) | 70200 |
| Mastoids (Complete, Min. 3 VWS) | 70130 |
| Facial Bones (Limited, <3 VWS) | 70140 |
| Facial Bones (Complete, Min. 3 VWS) | 70150 |
| Mastoids (Limited, 1-2 VWS) | 70120 |
| Mandible (Limited, 1-3 VWS) | 70100 |
| Mandible (Complete, Min. 4 VWS) | 70110 |
| Calcaneus (Min. 2 VWS) | 73650 |
| Foot (Complete, Min. 3 VWS) | 73630 |
| Toes | 73660 |
| Foot (Limited, Min. 2 VWS) | 73620 |
| Ankle (Complete, Min. 3 VWS) | 73610 |
| Tibia Fibula (2 VWS) | 73590 |
| Ankle (Limited, 2 VWS) | 73600 |
Consultation Codes for IR
Consultation codes are commonly used in IR to report office, inpatient, and confirmatory consultations. Here are some examples:
- 99241–99245: Office consultation codes.
- 99251–99255: Initial inpatient consultation codes.
- 99261–99263: Follow-up inpatient consultation codes.
- 99271–99275: Confirmatory consultation codes.
Structure of the E&M Coding Section:
Here is the breakdown of the Evaluation & Management (E&M) coding categories for IR:
| Category | Subcategory | Code Range |
|---|---|---|
| Office/Outpatient Services | New Patient | 99201–99205 |
| Established Patient | 99211–99215 | |
| Hospital Inpatient Services | Initial Observation Care | 99218–99220 |
| Initial Hospital Care | 99221–99223 | |
| Subsequent Hospital Care | 99231–99233 | |
| Consultations | Office Consultation | 99241–99245 |
| Initial Inpatient Consultation | 99251–99255 | |
| Follow-up Inpatient Consultations | 99261–99263 | |
| Confirmatory Consultations | 99271–99275 |
ICD-10 Coding in IR
ICD-10 codes report diagnoses, ensuring claims reflect the medical necessity of IR procedures. Accurate diagnosis coding includes:
- Primary and Secondary Diagnoses: Ensure all relevant conditions are documented. For instance, diabetic ulcers require codes for both the diabetes type and the ulcer specifics.
- Laterality: Specify the affected side to avoid denials.
Example:
- L97.523: Chronic ulcer on another area of the left foot with muscle necrosis.
- E11.621: Type 2 diabetes with foot ulcer.
Resource: Download CMS Guidelines
Selective Injections
When multiple selective injections are performed on the same day, it’s essential that the documentation identifies which vessels were catheterized. This ensures that the correct CPT codes are applied, including modifiers when necessary to indicate distinct services.
Documentation and Operative Reports
To ensure that claims are processed correctly, a signed operative or radiology report is often required when submitting claims for redeterminations or electronic claims. These reports must include the procedure details, patient information, and diagnostic findings, and they must support the selected CPT and ICD-10 codes.
Key Points for IR Coding
- Payer Policies and Coding Guidelines: Always be aware of the payer policies that may differ by insurance company, as well as any updates in coding guidelines.
- Compliance and Training: Ensure that all providers and staff are knowledgeable about their roles in coding compliance and that training is ongoing.
- Handling Denials: Denials should be addressed promptly, with proper documentation submitted as needed to resolve the issue.
- Internal Audits: Conduct regular internal audits to ensure accuracy in coding and billing processes. This is especially important in the complex field of IR.
Code Levels for Radiology Services
Radiology codes are organized into a hierarchical structure to categorize various radiological procedures. Here are the common types of radiology services covered by CPT codes:
- X-ray Procedures: Chest X-rays, bone X-rays, etc.
- CT Scans: For detailed imaging of organs and tissues from multiple angles.
- MRI: Imaging of soft tissues.
- Ultrasound: Used in various diagnostic procedures, such as obstetric or vascular imaging.
- Nuclear Medicine: Using radioactive materials for diagnostics and treatments.
- Mammography: For breast cancer screening.
- Fluoroscopy: Real-time X-ray imaging.
Key Strategies for Accurate Interventional Radiology Coding
Comprehensive Documentation
Detailed documentation is the backbone of IR coding. It must include:
- Procedures performed, including imaging type and number of views.
- Use of contrast materials.
- Detailed operative or radiology reports for review in case of denials.
Bundling and Modifier Use
- Use CPT modifier 59 to separate codes for distinct services.
- Avoid duplicate billing by adhering to the Correct Coding Initiative (CCI) edits.
Conclusion
By following these guidelines and using the correct CPT and ICD-10 codes, medical coders and healthcare providers can ensure proper billing and reimbursement for interventional radiology procedures. This not only promotes financial health but also helps maintain compliance with federal and payer-specific regulations.
Get free expert radiology RCM advice – Contact us (1-(518) 413-1817) today to ensure your radiology billing and coding are optimized for maximum reimbursement and efficiency.
