You know that submitting a clean claim and getting the right payment for radiology can be tricky. It takes good radiology billing and coding skills. Even though many claims get paid right away, insurance companies might do post-payment reviews and ask for money back. This can be avoided if you have proper documentation showing why the service is necessary. Since radiology services are being checked more closely, it's really important for you to have solid documentation. You must follow all the rules set by Medicare and other insurance companies.  

You must understand how to perform diagnostic test order in your radiology billing. 

Tips to handle diagnostic test order in your radiology billing services:  

  • You start your radiology services when you get a test order from the doctor who referred you. Then, you take it to an imaging center, hospital, or another place that does diagnostic tests. It's super important that the test order is complete and correct because Medicare will only pay for services that are needed. The doctor who referred you is responsible for showing that the test is necessary, according to Medicare's rules. 
  • As per the Balanced Budget Act of 1997, the doctor who has administered the test for your patient must provide the reason behind it. In case if the doctor is ruling out a specific condition, they also need to explain it.  
  • Always remember, if the information is missing, you need to contact the doctor who ordered the test to get the details before you can go ahead with the exam. 
  • The fact is, you need the signs and symptoms from the doctor who ordered the test to show why the procedure is needed. Even if the radiology report finds something unusual, you still need this info when you're doing the final coding. It helps you figure out if the finding is related to the patient's problem or just something random. 
  • If you order a test to “rule out” a condition, Medicare sees it as a screening exam. You need to code it that way if there aren't any signs or symptoms documented. Make sure you use a screening code as the main diagnosis and add any findings as extra diagnoses. This way, you're following the rules and avoiding any mistakes! 
  • You need to follow the ICD-10-CM rules for coding diagnostic services. Start with the main reason for the visit, like a problem or condition listed in the medical record, and put it first. You can also add other diagnoses, like chronic conditions, as extra codes.   
  • If you're doing routine lab or radiology tests with no signs or symptoms, use code Z01.89. But if the test is routine and also checks a specific problem, use both the Z code and the code for the problem.   
  • When a doctor has reviewed the test and written a final report, code the confirmed diagnosis. Don't include related signs or symptoms as extra codes. This way, you're coding things just right! 

Partnering with a radiology billing company makes managing these challenges much easier. Radiology billing outsourcing ensures accurate documentation, proper coding, and compliance with insurance rules, so you can focus on patient care. With expert support, you can reduce errors, avoid denials, and secure timely reimbursements, giving you peace of mind and better financial results.