Radiology lives or dies on the relationship between three things: the code, the modifier, and the place of service. A study read in a hospital and one read in your own imaging suite are billed differently even when the work is identical.
The second recurring problem is administrative rather than clinical. Missing referring-provider details stall claims that were otherwise clean, and they stall quietly, sitting in a rejection queue rather than coming back as a denial.
What trips radiology claims up
- Global versus split billing decided by site of service, not by habit
- Contrast and supply codes billed alongside the study where the payer allows it
- Repeat and comparison studies documented so they read as medically necessary
- Referring provider details captured, since missing ones stall the claim
What we check before a claim goes out
- Global versus split billing decided by site of service
- Contrast and supply codes billed where the payer allows
- Referring provider NPI captured at order, not chased afterwards