Coding and reimbursement resources

What do I need know?

IR's coding and reimbursement toolkit curates an array of society and external resources designed to help you better understand and meet the AMA CPT® codebook rules and guidelines. Providers (not coders) are ultimately responsible for using the CPT® coding system correctly. New coding changes for interventional radiology procedures occur annually and can be complex. These changes affect reimbursement and improper coding may result in penalties.

2023 Interventional Radiology coding update

The 2023 edition of the Interventional Radiology (IR) coding update is a valuable resource that provides information essential to coding and billing IR services correctly. The 2023 coding resource outlines the rules, guidelines, and systems in place that govern how coding should be done. In addition, this vital reference contains changes in CPT® 2023 codes, procedures frequently performed with practical coding guidance in each section, common coding questions, and charge sheets to help capture chargeable services. The 2023 edition is available in an electronic format for easy navigation. SIR members can access the e-publication for free. Non-members can also access this resource at a fee. Visit the IR Business Center.

2024 Navigator® coding manuals

The Navigator® coding guides, created by industry experts and interventional radiologists, and are full of clinical scenarios, authoritative guidance, and expert advice to ensure your documentation and coding leads to accurate claims and less hassle due to denials. Visit the IR Business Center.

2024 Navigator® Interventional Radiology Procedures: This manual is a comprehensive reference guide for interventional procedure coding. For each interventional procedure, the manual explains the procedure technique, coding guidelines (including references), documentation requirements, bundling rules, and coverage limitations. The guide also explains Medicare reimbursement policies like the multiple procedure payment reduction (MPPR) rules and the correct coding initiative. This is the only interventional coding guide you will need to buy!

2024 Navigator® Evaluation and Management Services for Radiology: This reference manual will help you cut through the confusion that surrounds radiology evaluation and management (E/M) services and determine when it's appropriate to report an E/M code and which code to report. If your radiology practice currently bills for E/M services or is thinking of billing for them, this book is a must-have.

Evidence-based carrier coverage letters

The SIR carrier advocacy team has developed several examples of common coverage request letters to help overturn carrier policy, denied authorizations, and denied claims.

Visit the IR Business Center for the newest updates.

Request a carrier advocacy coverage letter via the Carrier Advocacy Form

Coding application and guidance

Do you have a specific question regarding coding for an interventional radiology procedure? The SIR coding application and guidance workgroup are devoted to eliminating barriers in IR billing by providing coding guidance to SIR members. Our team constructs IR educational content to stimulate the demand for high-quality billing by increasing the value of SIR member resources. Ask your coding question here.

Looking for AMA books and eBooks?

To purchase CPT®, ICD-10, HCPCS books or any of the AMA’s other popular titles, please click the image above or follow the link here.

How will SIR help answer coding questions?

SIR's Health Policy and Economics Division will decide about questions that can be answered by SIR staff or sent on to the Coding Application and Guidance Workgroup of the Economics Committee, where expert volunteer physicians review each question and develop a response. Please allow one to two weeks for a reply. Once our volunteers provide their input, a consensus response is generated and sent back via email to the requester.
While the SIR Coding Application and Workgroup consists of experts in coding nomenclature, the SIR assumes no liability, legal, financial, or otherwise, for physicians or other entities who utilize this information in a manner inconsistent with the coverage and payment policies of any payors or Medicare contractors to which the physician or other substance has submitted claims for the reimbursement of services performed by the physician.

How can I keep current?

Read about common coding questions throughout the year in IRQ.
Learn how new consults for IR, pre-and post-procedural care, and inpatient rounding revenues help your practice in this presentation.
See SIR comment letters to CMS' proposed rule for Medicare physician fee schedule (MPFS), hospital outpatient prospective payment system (HOPPS), radiation oncology model (ROM), and other carrier advocacy work. SIR dedicates significant efforts to advocate for services completed by interventional radiologists properly.

Disclaimer:

The Society of Interventional Radiology (SIR) is providing this billing and coding guidance for educational and information purposes only. It is not intended to provide legal, medical, or any other kind of advice. This guidance is meant to be an adjunct to the American Medical Associations (AMA) Current Procedural Terminology (CPT® c. 2023). It is not comprehensive and does not replace CPT. Our intent is to assist physicians, business managers, and coders. Therefore, a precise knowledge of the definitions of the CPT® descriptors and the appropriate services associated with each code is mandatory for proper coding of physician service.

Every reasonable effort has been made to ensure the accuracy of this guidance; but SIR and its employees, agents, officers, and directors make no representation, warranty or guarantee that the information provided is error-free or that the use of this guidance will prevent differences of opinion or disputes with payers. This information is provided "as is" without warranty of any kind, either expressed or implied, including, but not limited to, implied warranties or merchantability and fitness for a particular purpose. The company will bear no responsibility or liability for the results or consequences of the use of this information. The ultimate responsibility for correct use of the Medicare and AMA CPT® billing coding system lies with the user. SIR assumes no liability, legal, financial or otherwise for physicians or other entities who utilize this information in a manner inconsistent with the coverage and payment policies of any payors, including but not limited to Medicare or any Medicare contractors, to which the physician or other entity has submitted claims for the reimbursement of services performed by the physician.

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