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IR Coding: 100% Bundled, Component Coded or Hybrid-Bundled

In 1992, CPT coding options for interventional radiology (IR) procedures underwent a seismic shift in “how” to code. Gone was the old method of complete procedure codes (a one-size-fits-all code); the new method added separate options to describe “what was done” and “where or how you did it.”

This method of separate components, using radiological supervision and interpretation (i.e., S&I or RS&I) codes as well as surgical or procedural codes, allowed providers to submit precise detail regarding what was done and where it was anatomically performed. While somewhat confusing to learn, this system recorded the highest level of detail (sometimes referred to as “granularity”) regarding the different types of diagnostic procedures, catheter placements, and transcatheter therapy services. Sometimes there were 2 codes, sometimes there were 7 codes, sometimes there were 20+ codes! Rarely was there only a single code.

While this system was excellent at providing detail, there were different opinions (mostly from payers) whether it was an equitable way to be “paid.” Lots of codes typically equaled lots of charges. As evident, a false step or misunderstanding in how to assign these component codes could result in gross overpayments. The same situation would be possible regarding a misunderstanding of the system and under coding, but as that resulted in underpayment it was never really a big concern on the payer side.

Fast forward to 2018, and where are we now? There remain component coded options, but there are also two other methods that might be used to compliantly and completely code for these types of services:

  1. 100% bundled codes, which is really where we were prior to the 1992 CPT code changes
  2. Hybrid-bundled codes, which is becoming more of the norm when new codes are added and is where some parts are bundled and some parts are component coded

Are you affected? Really, it depends on what your hospital provides and what your physicians perform. As both vascular (i.e., arterial, venous, pulmonary, portal, etc.) and non-vascular (i.e., GU, biliary, GI, etc.) procedures comprise IR services, my guess is that you are impacted.

When considering how this impacts your organization, the questions are numerous: What do you need to look out for? What has changed in the last several years? What changed this year? Are you ready? Do your coders and techs know about these changes and what happened? Are they aware of the nuances of the new codes? There are lots of potential pitfalls out there. What seems right might be, but you may be way off base as well. Really, how do you know for sure?

In my 25+ years of experience in this space, I have found that education and training in this area is one of the key ways to ensure your people are doing the right thing and your organization is capturing what it is legally entitled to. Let me know what your struggles are. My guess is that we’ve come across them before and are able to help. Donna Richmond, Cathy Huyghe, and myself collectively have nearly 100 years of experience in this area and can address both hospital and physician billing and coding issues. We’d love to help you!

Jeff Majchrzak, BA, CIRCC, RCC
Vice President, Radiology and Cardiology Consulting Services.