Interventional radiology (IR) is a medical specialty where doctors deploy medical imaging techniques to perform surgical procedures that are less invasive and can diagnose, treat, or cure a wide range of conditions. Various imaging methods include MRI, CT scan, and ultrasound. The radiologists at UVA Health System work in the Department of Vascular and Interventional Radiology.
During a normal interventional radiology (IR) treatment, the patient is positioned on an operating table beneath a specialized X-ray instrument called a fluoroscope. The radiologist, dressed in protective clothing such as a sterile gown and mask, carefully guides needles and wire-like tools into the patient’s body while intently watching real-time medical pictures on a screen. This new imaging approach enables the radiologist to traverse the body accurately, reducing the need for huge incisions.
Consultations vs. Office Visits
Consultation refers to a professional encounter in which a practitioner examines a patient and treats/suggests how they should be treated. If a patient encounters an interventional radiologist (IR) before a procedure, this may be considered a consultation, an office visit, or part of the procedure. If the patient’s chart contains a consultant’s opinion in addition to ordered or performed services, this must also be documented. A report of these observations must also be prepared and provided to the referring doctor in writing. This means that if the consultation is nomadic, in other words, it is requested by the patient or the family and not by a physician, it would have to be coded using office visit codes, not consultation codes.
Procedures and Techniques in Interventional Radiology
Interventional radiologists perform various procedures aimed at different body systems and conditions. Some of them include:
- Angioplasty and Stenting: This method is utilized to enlarge narrowed or blocked blood vessels and is frequently employed in treating peripheral and coronary artery disease.
- Embolization: Introducing substances that stop blood flow in a certain area, commonly used for treating issues like aneurysms or fibroids.
- Biopsies: Radiologists can use imaging direction to get tissues for diagnosis from almost all body parts.
- Drainage Procedures: To remove fluids from the body’s abscesses or other fluid collections.
- Tumor Ablation: Techniques like radiofrequency or cryoablation destroy cancerous tissues without requiring open surgery.
- Central Venous Access: Inserting catheters into large veins for chemotherapy, nutrition, or dialysis.
Patient Experience During IR Procedures
The atmosphere in an IR procedure room is very controlled for safety and patient ease. When a patient lies on the operating table, the interventional radiologist uses live imaging to help them guide instruments into their body. Protective covers are important for patients and medical team members, as they help reduce radiation exposure from fluoroscopy and other imaging techniques. All the controls and displays make it easy to see what is happening, and they quickly adjust things based on what shows up on the screens. This accuracy allows them to perform complex treatments through tiny incisions, significantly reducing the physical impact of typical surgery.
Determine If The Service is Separately Billable
The payment rules for E&M solutions use Global Period (GP). This GP starts on the day when surgery is carried out (or one day before if it’s a 90-day GP) and according to the CPT code for that procedure. This global span can last from 0 to 10, and in some cases, 90 days. Usually, E&M visits used to decide whether to do a procedure can be billed and paid if they occur outside the GP. In the GP period, all services related to the procedure are considered part of the surgical package and not reimbursed separately.
Consultations and Billing in Interventional Radiology
Regarding billing, it is important to note that Medicare does not recognize consultation codes. This signifies that office visit codes must be used for all Medicare patients. The significance of this distinction arises from the observation that consultation codes often have a greater repayment than office visit codes. Moreover, the understanding of “new patient” is also exact – it signifies an individual who the IR or any other doctor has not given professional services from the same IR group practice within the past three years.
Global Period and Billing Considerations
Global Period (GP) is crucial in understanding how billing for IR services functions. It encompasses the day when the procedure occurred and a specific period after surgery, where services related to that operation are considered part of the surgical package and cannot be charged separately. This period might be 0, 10, or 90 days, depending on the procedure. Services provided before or after this time or first meetings leading to a big operation (90-day GP) may be billed separately if properly noted with a Modifier –57.
Conclusion
Interventional Radiology is a field that relies on modern imaging methods to perform less aggressive surgeries. It is a rapidly evolving area, offering numerous advantages over traditional surgery. The treatments under it are less intrusive, more precise, and frequently superior in outcome.
