Study Supports New Codes in Radiology Billing to Support Uncompensated Work Image
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Study Supports New Codes in Radiology Billing to Support Uncompensated Work

The nature of radiology billing services could soon be changing. 

As radiology medical billing stands now, revenue cycle processes don’t accurately reflect the extensive work they do outside of image interpretation. These tasks can take up anywhere from 35% to 60% of their time. They can include work like consultations for their colleagues or traveling to attend conferences to review cases with professionals from other specialties. 

But a recent study from Yale School of Medicine examines this dynamic, looking at gaps in billing for services performed by radiologists and making recommendations to close gaps in radiology medical coding and billing [1]. Revenue cycle leaders who bill for radiology services should consider reviewing this study and the recommendations to better understand the challenges your clinicians face and the changes that could soon be coming to radiology medical billing. 

The Complexities of Radiology Billing Services

Radiology billing requires significant attention to detail because of the nature of imaging procedures.

Billers and coders must properly capture charges for X-rays, CT scans, and MRIs. Services like interventional radiology require precise coding with appropriate modifiers to avoid denials and delays in payment. One thing that sets radiology medical billing apart is the separation between the professional component (physician interpretation) and the technical component (equipment and staff). When a single entity provides both, a global charge applies, but in hospitals, split billing is common since radiologists bill separately for interpretations. 

Compliance is also a challenge in radiology billing. It is complicated by supervision requirements, payer-specific policies, and the need for thorough documentation, which must align to avoid denials. High-cost imaging also demands rigorous validation to support medical necessity. Revenue cycle leaders must invest the time and training in their staff to achieve these fundamentals. Without them, the risk of revenue leakage increases, making expertise in radiology medical coding indispensable.

The Hidden Workload: Unbilled Consultations in Radiology

Uncompensated efforts from radiologists should be a concern for healthcare leaders. 

These differences can impact patient care, but unfortunately, current contract and billing structures aren’t set up to capture their efforts or generate reimbursement. Even electronic consultation codes for interprofessional calls or assessment and management services that occur through the electronic health record (EHR) which could serve as a temporary solution, are underutilized due to documentation hurdles. 

According to the study authors, “such codes could theoretically provide a means of billing consultative work by radiologists, though there are practical barriers to use. Billing requires documentation of patient consent, which would likely need to be performed by the requesting physician in the case of ad hoc radiology consultation. These codes are [generally] reimbursed at lower RVU per unit time than E&M codes (as well as pathology consultation codes), which may not provide sufficient incentive for practices to implement new workflows, unless streamlined documentation and billing mechanisms can be put in place.”

The absence of structured billing processes for these services creates a financial gap, forcing providers to absorb the cost of unreimbursed labor. As radiology billing evolves, the demand for consultative roles will only grow. This inevitable growth makes it critical for leaders in radiology billing services to advocate for solutions that reflect the full scope of their radiologists’ contributions.

Burnout in Radiologists Is a Pressing Issue

The hidden workload of radiologists should be a priority for healthcare leaders, largely because of their risk of burnout. 

Burnout in radiologists often shows up as exhaustion, cynicism, and diminished self-worth. It’s also reached critical levels. 65% of female and 44% of male radiologists report that they feel burned out or both burned out and depressed. Even though physician burnout rates have stabilized some in recent years, 71% of affected radiologists have endured it for more than 13 months [2].

Burnout is associated with higher rates of turnover, reduced productivity, and an increase in medical errors – issues that cost health systems millions in recruitment and lost revenue. The American Association of Medical Colleges (AAMC) warns that radiology can’t afford to lose any more talent, since the specialty is already dealing with imaging overuse, stagnant residency slots, and the “silver tsunami” of aging Boomers. 

Closing the Gap: Strategies for Fair Compensation

To address these inefficiencies, Yale researchers propose a few solutions. One is dedicated CPT codes similar to those in pathology. These could account for ad-hoc and multidisciplinary consultations. Another is negotiating hospital contracts to include stipends for noninterpretive work or implementing academic RVU models to track unbilled hours for individual radiologists.  

Health systems can benefit from long-term incentives for consultations, especially as AI is used to streamline routine interpretations and free radiologists up for more complex case discussions. 

Academic and referral centers could benefit the most from restructured reimbursement models since consultative work is most prevalent in these organizations. 

Get in Front of Changes in Radiology Billing Services

As more professionals rethink this area of the healthcare revenue cycle, expect to see changes in radiology billing and even growing opportunities to improve reimbursement. These changes will have reverberating effects across your organization and aren’t something providers should try to navigate alone. 

We invite you to learn more about how 3Gen Consulting can support you in your radiology billing strategy and to contact us to learn more about the range of options you have in leveraging our expertise. Start your journey to improvements in your revenue cycle strategy here.

 

References

[1] S. Iftikhar, S. Rahmani, O. A. Zaree, A. Kertam, T. Farquhar and L. H. Tu, “The Value of Radiology Consultation: Effort Allocation, Clinical Impact, and Untapped Opportunities,” Journal of the American College of Radiology, 7 April 2025.
[2] C. E. Hudnall, “Burnout Fueling Workforce Woes,” 3 July 2024. Available: https://www.acr.org/Clinical-Resources/Publications-and-Research/ACR-Bulletin/Burnout-Fueling-Workforce-Woes.

Medical Coding Audits 101- How Physicians Can Stay Ahead of the Curve image
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Medical Coding Audits 101: How Physicians Can Stay Ahead of the Curve

You’re wrapping up a 10-hour shift. One more note to finish, one last patient to call – and then someone from billing walks in and says, “We’ve been selected for a medical coding audit.”

Cue the internal screaming.

Whether you’re running a private practice, part of a multispecialty group, or just trying to stay ahead in today’s value-based care environment, medical coding audits are the healthcare equivalent of a pop quiz —

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The Vital Role of Risk Adjustment Medical Coders Image
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The Vital Role of Risk Adjustment Medical Coders

In today’s value-based healthcare environment, risk adjustment medical coders are essential to the financial health, regulatory compliance, and care quality of U.S. healthcare organizations. As CMS continues to evolve its HCC risk adjustment models and intensify audit scrutiny, the expertise of these professionals plays a pivotal role in ensuring accurate reimbursements and minimizing risk. 

This blog explores the evolving responsibilities of risk adjustment medical coders, the impact of their work on HCC risk adjustment coding, and best practices for healthcare providers looking to

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AAP Releases 2025 Pediatric Billing Guide for Preventive Care 1
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AAP Releases 2025 Pediatric Billing Guide for Preventive Care

A healthy patient financial experience is critical for pediatric providers. Errors in pediatric billing, coding or documentation can lead to unfavorable outcomes such as unnecessary denials, prior authorization issues, and delayed billing – all of which can cause financial stress and extra strain on families with the added risk of reduced reimbursement for practices. 

To support accurate billing practices, the American Academy of Pediatrics (AAP) has released its 2025 Coding for Pediatric Preventive Care guide [1]. This document serves as a valuable resource for training and educating team members involved in pediatric billing services. We’ve compiled a summary of the most important sections for your review. For more detailed information, you can access the full pediatric medical billing document on the AAP website.

Preventive Medicine Service Codes

Preventive medicine service codes (99381–99385 for new patients and 99391–99395 for established patients) form the foundation for billing well-child visits. These codes encompass comprehensive evaluations that include age-appropriate medical history, physical examinations, and anticipatory guidance. Unlike traditional Evaluation and Management (E/M) codes, preventive codes are not time-dependent – code selection is based on the scope of services provided, not the length of the visit.

Accurate use of ICD-10 codes, such as Z00.121 for preventive visits with abnormal findings, also supports clean claim submissions. Understanding these nuances is critical to prevent unnecessary denials and underpayments. Partnering with pediatric billing companies who specialize in preventive care coding can further enhance reimbursement accuracy and financial performance.

Counseling and Behavior Change Intervention

Counseling codes (99401–99404) are used for time-based health promotion discussions on topics such as nutrition, safety, and pediatric mental health. These codes require documentation of the time spent but should not be billed in conjunction with preventive visits – a common error in pediatric medical billing. To ensure compliance with pediatric billing services, here are key points your billers should keep in mind:

  • Symptomatic patients: If counseling is related to an active condition (e.g., depression management), an office visit code should be used instead.
  • Group counseling: For sessions involving multiple participants, such as parenting classes, use code 99078.
  • Documentation: Billers must clearly document the counseling topics discussed and the duration of the session.

Because pediatric visits often involve extensive counseling, it’s essential that billers are properly trained to distinguish between preventive services and problem-focused care. Accurate coding is key to staying compliant and avoiding billing errors with pediatric billing services.

Health Risk Assessments

Health Risk Assessments (HRAs) for pediatric patients are specialized tools designed to evaluate the overall health and well-being of children and adolescents are an essential part of pediatric billing workflows. These assessments help healthcare providers identify potential physical, developmental, behavioral, and social risks early, enabling timely interventions to promote healthy growth and development.

CPT Codes for Health Risk Assessments

Developmental and Behavioral Screening

  • 96110: Developmental screening, with interpretation and report (e.g., developmental milestone assessments)
  • 96127: Brief emotional/behavioral assessment (e.g., ADHD screening)

Health and Behavior Assessment/Intervention

Sometimes used if specific behavioral health risks are assessed:

  • 96150–96155: Health and behavior assessment or intervention codes (may apply depending on service scope)

Outsourcing to pediatric billing companies with expertise in HRAs can help navigate payer-specific requirements and reduce denial risk.

Vaccines and Immunizations for Children

Vaccine billing is one of the most complex parts of pediatric billing. It depends on factors such as the child’s age and specific visit components – like multivalent vaccines. Navigating state-specific program requirements, Medicaid reimbursement guidelines, and frequent CPT updates (including those for COVID-19 and RSV vaccines) can be challenging.

One of the key benefits of working with pediatric billing companies is their expertise in maintaining accurate documentation and ensuring compliance with the continually evolving immunization policies, helping to optimize reimbursement and reduce errors.

Labs

Coding for labs in pediatric medical billing varies based on the testing location. When tests are performed in-house, your staff should bill for both the venipuncture procedure (36415) and the laboratory test. If the testing is outsourced, only the specimen collection code (99000 or 36415) should be billed. Additionally, staff must be well-trained in accurate ICD-10 code linkage to help minimize denials and ensure compliance with pediatric billing services.

Other Challenges in Pediatric Billing

There are many intricacies involved in pediatric billing – one of the most common being whether both a preventive and sick visit can be billed on the same day.

According to AMA CPT guidelines, if a provider addresses a new or existing condition that requires significant additional work beyond routine preventive care, both services may be billed together. To do so, the provider must document key elements of evaluation and management (E/M), such as prescribing treatment, adjusting medications, or performing a detailed assessment.

This situation frequently arises during well-child visits when a provider also manages chronic conditions like asthma, addresses behavioral concerns alongside ADHD screening, or evaluates acute issues such as a persistent cough. In these cases, modifier -25 must be appended to the E/M code to indicate a separately identifiable service performed on the same day.

Clear communication with families is essential. Many parents assume all services during a preventive visit are fully covered. Staff should be trained to explain that when problem-focused care is provided in addition to preventive services, copays or out-of-pocket costs may apply. Consider using signage or patient handouts to help set expectations and reduce billing misunderstandings.

Maximizing Value from AAP Guidance

As you review the AAP guidelines, be sure to explore the included vignettes – they offer valuable insight into pediatric coding for real-world scenarios.

At 3Gen Consulting, we deliver comprehensive pediatric billing services with specialized expertise in preventive care, immunization billing, and risk adjustment coding. Whether you’re strengthening internal teams or evaluating pediatric billing companies to enhance your revenue cycle, we’re ready to support you. Contact us today to learn how we can help.

 

References

[1] American Academy of Pediatrics, “Coding For Pediatric Preventive Care 2025,” 15 February 2025. Available: https://downloads.aap.org/AAP/PDF/Coding%20Preventive%20Care.pdf.

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