Workshop Planning Notes - IR & Cath Lab



Planning Notes For “Interventional Radiology & Catheterization Laboratory: Coding, Billing & Reimbursement

Course Title: Interventional Radiology & Catheterization Laboratory: Coding, Billing & Reimbursement

Objective: This is an intensive one-day workshop that is designed to address the coding and reimbursement under APCs surrounding services in interventional radiology and the catheterization laboratory. Particular attention is given to proper CPT coding in this area, setting up the charge master, establishing the coding and billing interfaces, APC payment difficulties, and the application of HCFA’s CCI (Correct Coding Initiative) and the proper use of modifiers. A review of the various types of radiological services, interventional radiology services, catheterization laboratory services and associated special radiological drugs and supplies will be reviewed. Professional coding and technical component coding will be compared and contrasted.

Intended Audience: All radiology and catheterization laboratory personnel and personnel involved in coding, billing and/or the charge master; Health Information Management Personnel, Charge Master Coordinators, Claims Transaction Personnel, Business Office Personnel and interested Clinical and Medical Staff Personnel.

Upon Completion The Participant Will:

1. Appreciate the technical difficulties involved with proper radiology coding and interventional radiology coding and billing.

2. Understand the need to carefully correlate surgical and radiological components for interventional radiology coding.

3. Appreciate the need and use of modifiers in connection with HCFA’s CCI (Correct Coding Initiative).

4. Appreciate the complexity of properly coding for catheterization laboratory services and electrophysiological procedures.

5. Understand the component approach to coding for interventional radiology, catheterization laboratory and various vascular procedures.

6. Understand how the APC prospective payment system groups and pays for these types of services.

7. Appreciate the way in which CPT and HCPCS coding systems have been developed in radiology and interventional radiology.

8. Appreciate the different ways in which the charge master can be set up relative to the overall coding approach taken for these areas.

9. Have worked through a series of examples that illustrate the coding techniques for these areas.

10. Understand the compliance implications for coding and billing in this area.

11. Appreciate the importance of identifying HCFA Interim Pass-Through List items for inclusion on the charge master and for service area personnel to charge.

12. Recognize sources for further information from specialty societies.

Outline:

I. Introduction

a. Review of Radiology Service Areas

b. Review of Interventional Radiology Processes

c. Review of Catheterization Laboratory Services

d. Overview of APCs for Radiological Services

e. Overview of the Charge Master

f. Overview of the Billing and Reimbursement Process

g. Physician Only Coding

h. Physician Evaluation and Management Services

i. CMS’s Transitional Pass-Through Listing

j. APC Cost Outliers

II. Diagnostic Radiology

a. Coding Conventions

b. Setting Up The Charge Master

c. Supply Considerations

d. Setting Charges Using RBRVS

e. HCFA CCI Edits

f. Modifier Utilization

III. Interventional Radiology

a. Charge Master Considerations

b. Radiology to Surgical Code Correlation

c. Supply and Equipment Concerns

d. CCI Edits and Modifier Utilization

e. Case Studies and Exercises

IV. Catheterization Laboratory

a. Proper Coding Processes

b. Developing Bundles of Codes/Services

c. Anesthesia/Recovery Services

d. CMA Transitional Pass-Through Items

V. EP – Intracardiac Electrophysiological Procedures

a. Component Coding

b. Arrhythmia Induction

c. Mapping

d. Ablation

e. Brief Case Studies/Examples

VI. Vascular Interventional Definitions

a. Selective

b. Nonselective

c. Arterial Coding Conventions

d. Venous Coding Conventions

e. Other Related Services

VII. Brief Anatomical Review With Codes

a. Vessel Ordering And Families

b. Thoracic Arch

c. Intracranial

d. External Carotid

e. Upper Extremity

f. Abdominal Aorta

g. Lower Extremity

h. Other Areas

VIII. Documentation Issues

IX. Compliance Issues

a. Non-physician Providers

b. Supervision Requirements

c. Independent Diagnostic Testing Facilities

X. Case Studies - Examples

XI. Exercises

XII. Sources For Further Information

Duration: This is an intensive one-day workshop. Typical meeting times are 9:00 a.m. to 4:00 p.m. with a lunch break.

Method of Presentation: Lecture-Recitation with exercises and case studies.

Student Materials: Extensive workshop notes will be provided. Students are required to bring the latest CPT manual for use in class. Charge slips and charge master sections are optional.

Note: References from the ACR (American College of Radiology) and SCVIR (Society of Cardiovascular and Interventional Radiology) will be available for review.

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