Feature Article
What Subway Can Teach You About Your Interventional Practice
We’ve all seen how a catchy $5 footlong jingle has made Subway the fast-food success story of the recession. Just seeing the words $5 footlong probably induces annoying jingles in your head; I suppose a testament to the advertisement’s success. Now let’s pretend you are a Subway franchisee. Corporate has recently added an additional promotion to the $5 footlong – for $1 more the customer can double the meat and cheese on the sandwich. Following the promotion, 90% of all customers that order the $5 footlong have opted to double up for $1 more. Unfortunately for you, your employee has failed to punch the double meat and cheese button on the cash register and has only charged the customers for the $5 footlong. So the customers order the double meat, receive the double meat, and think they’re paying for the double meat, but a failure on the part of your employee has increased your costs without increasing your revenue. But lucky for you, your astute CPA brought the anomaly to your attention and you’re now able to make the appropriate changes that stop the hemorrhaging of your hard-earned money. If you are wondering where I’m going with this, read on – your Subway franchise has everything to do with your Radiology Practice.
There are cases in nearly every practice where radiologists can at times resemble the Subway employee. That is, they’ll provide the best patient care money can buy, but incorrectly dictate the procedures performed. When that happens, your practice suffers. This is most evident in practices with a high volume of interventional work (IR) because the procedures are mostly high-dollar and the coding is extremely complex and highly specialized. Here is a list of some of the significant IR mistakes we regularly see, all of them with the potential to cost your practice thousands of dollars:
1) Incorrectly coding of vascular catheterization. For example, if you selectively catheterize a second or third order vessel, but fail to describe it in the direction or pick the proper codes in the proper order, your practice loses money.
2) Failing to dictate vessels selectively catheterized within in or in additional vascular families. (E.g., right and left carotids, right and left renals, left subclavian/vertebral and left carotid)
3) Placement of a stent as a result of an unsuccessful angioplasty. If you perform an unsuccessful angioplasty and then proceed with a stent placement, are you dictating and billing for both the angioplasty and the stent placement? You should be.
4) Biopsies of multiple lesions within the same organ or anatomic site. For example, if multiple biopsies of the liver are performed, regardless of how many lesions are biopsied, only one liver biopsy is coded and billed. If a significant amount of work was done, however we would consider appending the report with modifier-22 for "unusual procedural services." This would also be the case with the right or left lung. This, however, would, not be the case for breast lesion biopsies where biopsies of different lesions should be coded and billed separately.
5) Multiple angioplasties performed in dialysis access maintenance procedures. This is often times incorrectly coded to the detriment of the practice. The fistula is considered one vessel up to the axillary vein and should be coded ad G0393/75978 and if another angioplasty is performed outside the fistula it should be coded as 35476-59/75878-59.
6) Missing the coding of follow up injections post embolization procedures. When you perform follow up post embolization studies, are you certain these are all dictated, coded and billed? Is it coded correctly if done extracranial vs. intracranial?
7) Missing the coding of vascular ultrasound when performed in procedures other than central line placement. When utilizing vascular ultrasound for U/S guidance and stating that permanent record of the image was maintained so that it can be billed and you can get paid for the work done?
These are just a few areas where we identify lost revenue and bring it to the attention of the performing physicians with whom we work. Do you have an astute CPA like the Subway franchisee that can bring lost revenue to your attention? Are you receiving dictation feedback and being asked to add the appropriate addendums to reports so that you can collect what you have rightfully earned? These are questions you should ask of your billing personnel or agency because if not, you may be behind your peers who may be collecting more of what they have earned and as a result, being more highly compensated.
