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Interventional radiology (IR) is a growing field of medicine involving minimally invasive procedures that are performed using imaging guidance. They include procedures that have traditionally been performed in the Operating Room. Interventional radiology procedures are generally less costly and less traumatic to the patient as compared to traditional approaches, requiring only tiny incisions and shorter hospital stays. Under the guidance of radiologic images, interventional radiologists insert catheters and other tiny instruments through blood vessels and other channels within the body to diagnose and treat a wide variety of conditions percutaneously.

Coding and charging for outpatient injections and infusions requires a thorough understanding of coding guidelines, facility charge protocols, various types of medication administration, and documentation requirements. The Centers for Medicare & Medicaid Services (CMS) sets forth payment policy for Medicare hospital outpatients, using the outpatient prospective payment system (OPPS). CMS currently defers to the American Medical Association (AMA) for coding guidelines associated with injection and infusion coding. These guidelines are part of the AMA's Current Procedural Terminology (CPT) codebook. Because these codes are typically hardcoded in the facility's charge description master (CDM), the coding and charging of injection and infusion procedures also impacts charge-based payers. The purpose of this training manual is to provide an educational and resource tool for accurate coding and charging of injection and infusion procedures performed in outpatient hospital units. Coding guidelines for physician services are different than those for hospitals and are not discussed in this publication.

In 1983, when the Social Security Amendments completely revised the cost-based payment system for hospital inpatient services, many hospitals began to utilize observation services in ways that were not intended by Medicare. This inappropriate use has led to increased regulatory scrutiny to ensure that patients who are admitted as inpatients meet the specified inpatient criteria. Therefore, in 1996, the implementation of regulations for observation status was completed. These regulations defined the appropriate use of observation status, and they are still being used. Even though the reimbursement is continually updated, the directives for the correct use of observation status have not significantly changed. The updated regulations can be found in the Medicare Benefit Policy Manual and the Medicare Claims Processing Manual. This module provides an in-depth discussion and explanation of the intricacies involved with coding outpatient observation services. with coding outpatient observation services.

Project focus: to identify potential opportunities for revenue enhancement, as well as to identify compliance risks.

Project focus: to identify potential opportunities for revenue enhancement, as well as to identify compliance risks.

Interventional radiology (IR) is a growing field of medicine involving minimally invasive procedures that are performed using imaging guidance. They include procedures that have traditionally been performed in the Operating Room. Interventional radiology procedures are generally less costly and less traumatic to the patient as compared to traditional approaches, requiring only tiny incisions and shorter hospital stays. Under the guidance of radiologic images, interventional radiologists insert catheters and other tiny instruments through blood vessels and other channels within the body to diagnose and treat a wide variety of conditions percutaneously.