CPT code blunders cost one radiology practice more than $20K per month, new analysis shows
Delays in adopting new current procedural terminology codes cost one academic radiology practice hundreds of thousands of dollars in revenue, according to a new analysis.
Each year, the American Medical Association elects an editorial panel to audit CPT codes and institute necessary edits. While effective coding is crucial to physician billing practices, it’s well-known that many radiologists and other specialty providers fall short in this area.
And for one large radiology organization, education and communication lapses in reporting new moderate sedation codes resulted in losses of upwards of $21,000 per month over a 17-month period.
Taking this hit to the bottom line should serve as a warning for other organizations, Duke University researchers wrote March 13 in Current Problems in Diagnostic Radiology.
“While today many practices have undoubtedly adjusted to moderate sedation coding changes, this work highlights the critical importance of adopting preventative and preparative strategies to effectively transition coding and billing operations after CPT coding paradigms are altered,” corresponding author Jonathan G. Martin, MD, with Duke Health’s Department of Radiology, and colleagues added.
For their findings, the team collected billing and reimbursement data between January 2017 to the end of April 2019. They specifically compared moderate sedation code reporting to the number of radiology-performed procedures during the 28-month study period. In 2017, the AMA implemented a coding change unbundling moderate sedation from procedural codes, creating a new separate set of billable codes with “significant” financial effects, the authors explained.
Upon analysis, Martin et al. found the practice did not adequately achieve appropriate coding until June 2018, amounting to a nearly 17-month delay in implementation.
In 2017—when the change went into effect—MS was reported with 2.5% of cases, they explained. That figure jumped to 47.8% in 2018 and 69.1% in 2019. All in all, however, the failures resulted in a $363,069 (± $67,065) loss of procedural revenue, according to the group’s root cost analysis.
And what drove the delays? Lags in education and coordination at multiple points along the reporting chain, among other problems, Martin and co-authors found. Longer lead times and earlier meetings would have been beneficial, as would have adjusting report templates prior to coding changes.
Taking these precautions will be particularly important as practices contend with the U.S. Centers for Medicare & Medicaid Services’ planned 2021 changes to evaluation and management (E/M) coding that’s projected to lower overall radiology payments, Martin and colleagues explained.
“As healthcare policy shifts and changes to coding become more frequent and significant, timely adoption becomes more salient for radiologists,” the authors concluded.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.