Why Should Radiologists Use a Certified Coder?

An ACR coding expert explains the ins and outs of this radiology-specific certification.

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Physicians know that accurate coding can be critical to a practice's survival. If you under-code, there's lost revenue. If you over-code, you run the risk of possible fraud and abuse charges.

Radiologists grappling with coding may want to consider hiring a certified coder to manage the nuances of a complex and ever-changing process.

In a recent interview, Diane Hayek, former director of the ACR Economics and Health Policy Coding Section and past industry director of the Radiology Coding Certification Board® (RCCB), outlined the job duties and skill sets of a radiology certified coder.

What exactly is a radiology certified coder?

A radiology certified coder has earned the Radiology Coding Certification (RCC) designation which recognizes an accepted level of competency and expertise in radiology-specific coding and compliance with federal regulations. A number of coding certification exams are available (e.g., the Certified Professional Coder exam), however, the RCC designation is specific to radiology. Radiology certified coders may include physicians and managers.

What role does a certified coder play in the chain of care?

A certified coder ensures the procedures ordered and performed are appropriately billed according to industry guidelines. The coder would also confirm that documentation is adequate to support the codes reported. Accurate and complete documentation is essential as we move to a value-based compensation system under the Merit-Based Incentive Payment System. The certified coder helps to ensure the radiology practice will be reimbursed appropriately for services rendered and can protect the practice against fraud and abuse charges.

Is there currently a shortage of certified coders in radiology?

Yes, there are currently only about 900 RCC-certified coders. I continue to hear from a number of practice managers that they have difficulty finding RCCs. If you want to ensure you have competent coders, go to www.rccb.org to learn more about the RCC certification and how your coders can become certified.

How is the radiology certification process unique?

While a number of coding certification exams are offered, they only offer a few questions specific to radiology coding. Because of this, a radiology-specific exam was developed in 2000 by the RCCB. Now, because of the increasing complexity of IR coding, the RCCB is developing an IR-specific certification exam.

What are some of the benefits of having a full-time coder on staff?

A radiology-certified coder on staff can discuss issues directly with physicians, identify problems specific to each site, work with a compliance officer, and provide customized auditing and training for the radiology practice.

How can practices justify the cost of a coder?

Certified coders who appropriately capture revenue for services rendered should more than pay for themselves by avoiding denied claims, underpayment, or no payment at all. Revenue lost by inappropriate coding could be even greater and quite substantial if the practice is subjected to fines for violating billing regulations. Certified specialized coders may require a higher salary compared with other coders; however, the level of expertise and training required makes them a valuable resource for practices.

Some radiologists won't work at a practice where there isn't a certified coder on staff. Why is that?

The financial climate is continuously changing and having a certified coder directly available to radiologists to answer coding, billing, and documentation questions is invaluable. Although documentation is the radiologist's responsibility, a certified coder can educate and inform where other coders may not have that skill set. Even with automation or off-site coding, there is no replacement for in-person oversight, auditing, and training.

By Chad Hudnall, managing editor, ACR Press

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