Original article
Radiology Coding, Reimbursement, and Economics: A Practical Playbook for Housestaff

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As radiologists-in-training, residents and fellows have little time to devote to understanding the complex and often confusing world of reimbursement and radiology economics. At best, housestaff are afforded only a modicum of exposure to the economics of medicine. Although most training programs try to provide some information on the subject, between learning radiology, taking call, and juggling life outside the hospital, the majority of residents and fellows have little time or energy to learn about the economics of radiology. Furthermore, information on medical economics and radiology has only occasionally been directed specifically to housestaff or widely distributed to residents across the country. This is unfortunate because the reimbursement and economic arena will significantly affect daily practice, relationships with other specialties, and compensation. In this article, the authors briefly describe the current reimbursement and economic climate: how we got here and where we may be headed, with specific attention to coding for radiologic services. In addition, and perhaps more important, the authors highlight aspects of residents' or fellows' daily practice that may have the potential to affect reimbursement in their years of practice ahead, such as proper dictation and coding techniques, the importance of adhering to new reporting guidelines, and the need for increased radiologist involvement in professional and community activities. The authors also emphasize measures that can be taken, specifically by housestaff, to promote and preserve the image of our specialty, which ultimately is intertwined with the reimbursement and economics of our field.

Section snippets

Coding and Reimbursement: X's and O's

In the 1960s, both medical care and computer technology were rapidly growing in sophistication. In response, the American Medical Association (AMA) developed the Current Procedural Terminology® (CPT®) in 1966 to describe medical, surgical, and diagnostic services. Over the past 4 decades, CPT has continued to grow in influence, shaping the path our specialty has taken [1]. The CPT was created to communicate uniform information about medical services and procedures among physicians, coders,

Coding and Reimbursement: Calculating the Yardage

Once a Category I CPT code has been established, the service undergoes evaluation by the RUC. This committee is composed of members representing the entire medical profession, with 23 of its 29 members appointed by major national medical specialty societies, including those recognized by the American Board of Medical Specialties, those with large percentages of physicians in patient care, and those that account for high percentages of Medicare expenditures. The Resource-Based Relative Value

Coding and Reimbursement: Keeping Score

With regard to payment for imaging, many readers may be familiar with the current system, whereby each radiologic CPT code has a professional component describing the payment for the physician work and PE for billing and administration and a TC, which is a PE payment related to providing the technical portion of the examination outside of a hospital facility, including physicians' offices, diagnostic imaging centers, and independent diagnostic testing facilities. The professional component is

Play Like You Practice

Undeniably, the habits radiologists develop while in training persist into private or academic practice. As the old coaching adage goes, you “play like you practice.” As housestaff working and learning in reading rooms and interventional suites today, how can we better position ourselves to ensure quality practice and accurate reimbursement in the future?

Early in residency, our faculty members emphasize the importance of the written radiology report. It serves a vital role in guiding and

Improving the Image of the Team

How often have you been asked by a family member what you actually do as a radiologist? In recent years, the ACR leadership has launched an aggressive campaign to strengthen the image and reputation of our specialty. The campaign focuses on educating patients regarding the role we play as imaging experts. As housestaff, we are perfectly positioned to spearhead the efforts of the ACR to define how the public perceives radiologists. We are often the first, and sometimes only, radiologists

Preparing for Involvement Beyond the Playing Field

As they near the transition from residents or fellows to partners or attending radiologists, housestaff should become more mindful of the need to develop and maintain involvement in the specialty beyond daily clinical practice. Certainly, between now and Louisville, it is difficult to see the importance of this, but beyond certification lies multiple arenas we need to be a part of to advance the specialty. First, we need to encourage ACR and governmental participation among our colleagues in

Postgame Analysis

The dynamic arena of coding, economics, and reimbursement will continue to present new challenges and opportunities for our specialty, particularly for newly minted radiologists as administration changes have recently taken place in Washington. The ACR has done much to keep housestaff updated and informed regarding what may be on the horizon, and our leadership works tirelessly behind the scenes to maintain the value of our field. At a glance, some of the simple points highlighted above may not

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