Exploratory Study of Radiology Coding in Health...

Exploratory Study of Radiology Coding in Health Information Management Practice 1

Exploratory Study of Radiology Coding in

Health Information Management Practice

by Melanie Brodnik, PhD, RHIA

Abstract

An exploratory study was undertaken to determine the role and practice issues of radiology coding in

health information management (HIM) practice. The study sought to identify the challenges of radiology

coding and the solutions implemented to address these challenges. A self-report survey was sent to 828

American Health Information Management Association (AHIMA) members identified as directors,

managers, or supervisors of HIM departments and/or coding. Two hundred seventy-eight surveys were

used for data analysis purposes. Sites reported that on average they have 3.4 coders devoted to radiology

coding who code an average of 4,245 reports per month. Productivity standards varied by exam type

ranging from 7 (interventional radiology) to 31 (diagnostic) exams coded per hour. Diagnosis codes were

assigned most frequently for diagnostic, ultrasound/nuclear, MRI/CT, and mammography exams, while

diagnosis and procedural codes were assigned more frequently for interventional radiology exams. The

need for education specifically focused on interventional radiology coding was identified along with other

issues affecting the quality of radiology coding. Suggested solutions to challenges of radiology coding

such as establishing a good working relationship with physicians, radiology, and charge description

master (CDM) departments were suggested.

Key words: Radiology coding, reports, lists, reimbursement, coder, credentials, productivity

standards, coding role, coding volume, continuing education

Introduction

A major job function within the health information management (HIM) profession is the assignment

of medical diagnoses and procedures codes for administrative, financial, clinical, and research purposes.

Systems for classifying diseases and procedures have been in existence since the late 19th century and

have evolved over time to meet the data demands of the healthcare industry. Coding originally supported

the need for clinical and research data; however, with the advent of Medicare and Medicaid the use of

coded data has expanded to support the financial and reimbursement needs of the industry.1 Coding is

now a major component of the billing and reimbursement processes of healthcare providers. It must be

done in a timely and accurate manner for healthcare providers to receive payment for services rendered.2

The importance of coding cannot be overemphasized as the industry and federal government implement

programs to control healthcare spending (e.g., prospective payment systems, present on admission [POA]

reporting, recovery audit contractor (RAC) reviews) that rely heavily on quality coded data.3, 4

The

challenge for healthcare providers is to ensure that all services rendered are identified and assigned codes

according to correct coding guidelines.

Radiology is one of these services. Radiology diagnostic and/or treatment procedures must be coded

to meet federal regulations for Medicare and Medicaid reimbursement requirements. Past federal

2 Perspectives in Health Information Management 6, Fall 2009

mandates requiring that interventional radiology and diagnostic angiography be coded using the

Healthcare Common Procedural Coding System (HCPCS) (inclusive of Current Procedural Terminology

[CPT]) followed by implementation of the Ambulatory Payment Classification (APC) system in 2000

have called attention to the need for accuracy and quality of coding but also to the need for individuals

with expertise in radiology coding.5-7

The nuances of coding and increased federal regulations make

radiology coding particularly challenging. In addition, anecdotal information suggests that hospitals and

imaging centers may experience difficulty staying ahead of the curve in radiology coding.8

Increased attention to timely claims reporting and reimbursement accuracy has pushed the importance

of radiology coding to the forefront. This type of coding has the potential of becoming an important

domain in HIM practice as the federal government pushes for healthcare reform through quality oversight

and cost containment programs.9 Although HIM professionals have been responsible for diagnosis and

procedure coding in a variety of healthcare venues, little is known regarding the role of HIM

professionals in the domain of radiology coding. Thus, an exploratory study was undertaken to better

understand the role and related practice issues of HIM professionals engaged in radiology coding. The

study also sought to identify the challenges of radiology coding and the potential solutions to these

challenges as implemented by HIM professionals.

Research Questions

The research questions used to guide this study were as follows:

1. Who is responsible for radiology coding in selected healthcare facilities?

2. What are practice issues as related to report types, what is coded, productivity standards, quality

audits, volume of reports, and continuing education needs?

3. What challenges do healthcare providers who engage in radiology coding face?

4. What solutions have been implemented to address the challenges of radiology coding?

Methods

The research design for this study was a descriptive exploratory survey method that used a 15-item

Web-based survey instrument (see Appendix A). The instrument was developed with input from experts

in the field. It was also field tested and revised based on expert feedback. The survey consisted of six

demographic questions (items 1–4, 12, and 13) and nine practice-related questions (items 5–11,14, and

15). Respondents were offered the opportunity to request a summary of the survey results and to be

entered into a lottery for a gift as an incentive to complete the survey (items 16–18). Approval for the

survey was sought and granted by The Ohio State University Institutional Review Board. An electronic

survey application (SurveyMonkey) was used to distribute the survey to a sample of 828 individuals from

the AHIMA Member Profile Database. The sample was composed of those individuals who identified

themselves as director, manager, and/or supervisor; assistant or associate director, manager, and/or

supervisor; coding manager; or billing manager. A follow-up reminder was sent approximately two weeks

after the initial mailing to encourage completion of the survey.

Results

Survey Return Rate

Surveys were sent using an electronic survey method to 828 individuals. Twenty-nine individuals

responded that they either were not the appropriate person to respond to the survey or were not working in

the area. Thus, the adjusted number of surveys was 799, of which 278 were returned for data analysis

purposes. This represents an adjusted survey return rate of 34.8 percent. Results of the survey are

discussed below by research question. Frequencies and percentages may vary since many questions

allowed the respondent to select more than one response.


Responsibility for Radiology Coding

Six demographic questions were asked to determine who was responsible for radiology coding in a

given facility. The questions related to job title, professional credentials, employment setting,

responsibility for coding, number of coders, and the coders’ credentials.

Job Title and Credentials of Respondents

Respondents were asked to identify their job title and what if any credentials they held (Table 1).

Respondents could select more than one credential if appropriate. The majority of respondents (54.4

percent, n = 160) were department directors, managers, or supervisors and/or assistant or associate

directors, managers, or supervisors. The second largest group of respondents were coding managers (37.6

percent, n = 103). The RHIT (Registered Health Information Technician) credential (53.6 percent, n =

148) was held by the majority of respondents, followed by the CCS (Certified Coding Specialist) (38.4

percent, n = 106) and RHIA (Registered Health Information Administrator) credentials (35.5 percent, n =

98). The remaining credential choices were held by limited numbers of respondents. In the “None” and

“Other” categories, 11 of the 20 respondents identified academic degrees rather than credentials, and 4

identified the Physician Coding Specialist (PCS), Facility Coding Specialist (FCS), Advanced Coding

Specialist-Obstetrics (ACS-OB), and Certified Health Physicist (CHP) credentials. In addition to the

RHIT and RHIA credentials, the researcher was interested in the various credential combinations by job

title that the respondents might hold. Table 2 provides an example of some of these combinations.

Employment Setting and Responsibility for Radiology Coding

Respondents were asked to indicate their employment setting and if their employment setting was

responsible for facility radiology coding only, was responsible for physician practice radiology coding

only, was responsible for both facility and physician practice coding, or had no responsibility for

radiology coding (Table 3). Results revealed that the primary employment setting was the HIM

department (82.4 percent, n = 224). Of respondents who chose “Other” (5.4 percent, n = 15), four

identified themselves as working in an integrated hospital system and four listed “corporate” as their

employment setting. This may mean that the coding function for radiology is centralized at a corporate

level rather than in a specific HIM department. Two respondents identified their setting as consulting

firms, and two indicated they worked for professional medical societies. The remaining employment sites

were identified as occupational health, HMO, community health center, and skilled nursing facility

(SNF).

In regard to responsibility for radiology coding, 72.5 percent (n = 198) of the respondents indicated

their department or unit was responsible for radiology coding, while 27.5 percent (n = 75) said their

department or unit was not responsible for it. Respondents who were not responsible for radiology coding

were directed to the end of the survey and were excused from completing the remainder of the survey. Of

the 198 who responded that their employment setting was responsible for radiology coding, 63.7 percent

(n = 174) indicated they did facility radiology coding. Only two respondents indicated they did physician

practice radiology coding, while 8.1 percent (n = 22) indicated they did both facility and physician

practice radiology coding.

Coders Dedicated to Radiology Coding

Respondents were asked to indicate how many coders were dedicated to radiology coding in their

employment setting. Of the 189 who responded, 15 indicated that they did not know how many coders

were dedicated to radiology coding and 11 commented their coders were cross-trained to code a variety of

reports and were not dedicated specifically to radiology coding. The remaining 163 respondents reported

that a total of 480 individuals were dedicated to radiology coding (Table 4). This number translates to an

average of 3.4 full-time equivalents (FTEs) per employment setting with a range of 0.1 to 97 FTE coders

per site.


FTE Coders and Credentials

The last demographic question asked respondents to indicate the number of FTEs responsible for

radiology coding and to identify their credentials. Respondents included coders who were responsible for

radiology coding as well as other forms of coding. Respondents identified a total of 550.75 FTE coders

with the top three credentials reported as RHIT, CCS, and CPC (Certified Professional Coder). Of the 171

respondents who answered the question, 53.8 percent (n = 92) reported that 230.75 FTE coders held the

RHIT credential, 39.2 percent (n = 67) reported that 124 FTE coders held the CCS credential, and 18.1

percent (n = 31) reported that 61.5 FTE coders held the CPC credential. Responses in the “Other”

category identified four coders with the LPN credential, with the remaining comments related to unknown

professional credentials or individuals not yet credentialed. Table 5 provides a summary of the responses

along with the reported number of FTE coders per credential.

Practice Issues Related to Radiology Coding

Seven questions were asked that addressed radiology coding practice issues related to whether coding

is done from reports or lists, what is coded by exam type, productivity standards for reports and for lists,

quality audits, and continuing education needs.

Reports and Lists

The first practice question asked respondents to indicate if coders coded from reports or lists.

“Report” refers to an individual patient radiology report that is generated as a result of a radiology service

rendered to a patient. Lists refer to lists of patients who received radiology treatment for a given time

frame (by day, for example) that usually include dates of services, identifying information of patients

receiving services, and diagnoses and/or procedures. Sixty-nine percent (n = 134) indicated coders coded

mainly from individual radiology reports with a combination of reports and lists as the second choice

(13.4 percent, n = 26) (Table 6). Of those who indicated “Other,” the majority identified orders

(physician, admission, and/or requisition) as the source from which codes were assigned followed by

coding from the superbill, charge ticket, and/or chargemaster.

Coding Role

The second practice question asked respondents to indicate what was coded based on the type of

radiology exam (diagnostic, ultrasound/nuclear, MRI/CT, interventional radiology, and mammography)

(Table 7). In regard to exam types of diagnostic (n = 115), ultrasound/nuclear (n = 114), MRI/CT (n =

112) and mammography (n = 110), results revealed that sites code diagnosis only most frequently

followed by adding modifiers to CPT procedures. Approximately 25 percent of the respondents code both

the diagnosis and CPT procedure from these exam types, with about 18 percent coding the diagnosis and

chargemaster (CM) procedure code. However, in regard to interventional radiology, respondents indicated

that both diagnoses and procedures (n = 104) were coded more frequently than diagnosis only. Sites also

add CPT modifiers more frequently for interventional radiology exams than for other exam types. Sites

code diagnoses and chargemaster (CM) codes for interventional radiology about the same as for the other

exams. Altogether, a very small number of sites coded only CPT procedures.

Volume of Radiology Coding

The third practice question related to the volume of radiology coding done per month. Ninety-seven

respondents provided monthly volume figures that ranged from 5 to 60,000 exams per month with an

average volume of 4,245 per month. One eight-hospital system indicated that their volume was 95,000

collectively or 11,875 per facility per month. Four respondents identified that they only coded

interventional radiology exams, which ranged from 40 to 500 per month. It is interesting to note that of

the 198 possible respondents, only 97 provided information on volume, which raises the question as to

why the others did not. Several commented that they did not keep this information, while others simply

responded that they did not know.


Productivity Standards

The fourth and fifth practice-related questions addressed productivity standards for coding reports and

lists. Respondents were asked to indicate if productivity standards were maintained for the various

radiology reports and, if so, to enter the standard. Fifty-nine percent (n = 89) of the 151 individuals who

responded to the question indicated they maintained productivity standards for the various reports versus

41 percent (n = 62) who indicated they did not maintain productivity standards. The data were summed

and averaged to determine an hourly standard by exam type. In regard to “Other,” of the 25 responses, 18

indicated no standard was kept, while 7 offered a general productivity standard of 75 to 100 reports per

day regardless of exam type. The same question was asked in regard to productivity standards for coders

who coded radiology procedures from lists. Of the 87 responses, 31 percent (n = 27) indicated that

productivity standards were maintained for radiology coding from lists. The majority of respondents (69

percent, n = 60), however, reported that they did not maintain standards. Table 8 provides a summary by

percent and frequency for those who responded positively to the question along with the range and

productivity standard per hour for the various exam types.

Quality Audits

As a follow-up to productivity standards, respondents were asked to indicate if separate radiology

coding quality audits were performed by their employer. Anecdotal information revealed that quality

standards fell between 95 and 98 percent. The majority of respondents (47.7 percent, n = 93) indicated

that radiology coding audits were included in routine coding audits. Twenty-seven percent (n = 52)

reported that separate radiology audits were performed, while 22 percent (n = 43) reported that audits

were not conducted.

Continuing Education

Given the complexity of radiology coding and continuing regulatory changes, the need for continuing

education is important; thus, the respondents were asked how satisfied they were with opportunities for

continuing education and/or training related to radiology coding. They were also given the opportunity to

comment on the need for education in this area of practice. Overall, the respondents appeared to be

satisfied to very satisfied with educational opportunities regarding radiology coding (Table 9). Twenty-six

respondents offered comments that focused on the need for educational programming in the area of

interventional radiology. It is interesting to note that nearly 14 percent (n = 27) of the respondents were

not aware of continuing education programs for radiology coding.

Challenges to Radiology Coding

Respondents were asked to identify what if any challenges their employment setting faced in regard

to radiology coding. Respondents were given nine challenges to select from in addition to space for

comments in the “Other” category (Table 10). Eighty-four percent (n = 158) of those who responded to

the question indicated that they faced one or more challenges in their employment setting while 16.4

percent (n = 31) indicated no challenges. The top five challenges were lack of physician documentation

(42.3 percent, n = 80), keeping up with payer rules and edits (38.6 percent, n = 73), lack of continuing

education opportunities in radiology coding (28 percent, n = 53), access to expert coders (24.9 percent, n

= 47), and high volume of work (21.7 percent, n = 41).

Solutions to Challenges

The last question was open-ended and provided the respondents with the opportunity to comment on

whether their employment setting had successfully addressed any of the above challenges. Fifty-four

respondents offered comments regarding solutions to their radiology coding challenges. Comments were

reviewed and grouped by solution theme. The most prevalent solution noted was to offer staff education

and training programs. The second most prevalent response focused on the importance of establishing

working relationships with physicians, the radiology department, and/or the chargemaster management


department. The third solution was the use of consultants to fulfill coding and/or training needs. Fourth,

respondents sought to hire individuals with credentials and/or specializations in radiology coding. The

last solution theme centered on implementation and use of technology applications to confirm the medical

necessity of procedures.

Discussion

An exploratory study of radiology coding in HIM practice was conducted to better understand the

HIM role in radiology coding and to identify issues and challenges related to this specialty area of coding.

An electronic survey was sent to 828 AHIMA members who had identified themselves as department

director, manager, or supervisor; assistant or associate director, manager, or supervisor; coding manager

or billing manger. Two hundred seventy-eight surveys were returned for a 34.8 percent return rate. The

majority of respondents indicated that their employment setting was responsible for facility and/or

physician practice radiology coding and that they mainly coded from radiology reports. Sites reported on

average that 3.4 coders were engaged in some form of radiology coding. The most common professional

credentials held by coders were RHIT, CCS, and/or CPC. The average number of reports coded per

month was 4,245 with a range of 5 to 60,000 reports per month. As expected, the more coders at a site,

the more radiology reports were coded.

Coders tended to code diagnoses only followed by adding CPT modifiers for diagnostic (n = 115),

ultrasound/nuclear (n = 114), MRI/CT (n = 112), and mammography (n = 110) exams. Approximately 25

percent of the respondents coded both the diagnosis and CPT procedure from these exam types with about

18 percent coding the diagnosis and chargemaster procedure code. However, for interventional radiology,

both diagnoses and procedures (n = 104) were coded more frequently than diagnosis only. Sites also

added CPT modifiers more frequently for interventional radiology exams than for the other exam types.

Sites coded diagnoses and CM codes for interventional radiology with the same frequency as the other

exams.

Productivity standards for radiology coding varied by exam type and ranged from 7 per hour for

interventional radiology exams to 31 per hour for diagnostic exams. The productivity standard for all

reports was 24 per hour. It is not surprising to find a difference in productivity standards based on exam

type since interventional radiology may encompass more complex diagnoses and procedures. Very few

employment settings appear to code from lists. However, for those respondents who indicated that their

site coded from lists, the productivity standards were not much different than coding from reports except

for interventional coding, where the average productivity standard for coding by reports was 7 versus 21

from lists. Because few respondents indicated that they code from lists, the standards are questionable.

However, the quality of radiology coding is important given issues related to claims reporting and

reimbursement accuracy. Overall, 73 percent of the respondents indicated that quality audits were

performed on radiology coding.

In regard to continuing education needs, the majority of respondents reported that they were satisfied

to very satisfied with the continuing education and/or training opportunities available to them. However,

comments offered by respondents also indicated a need for education specifically focused on

interventional radiology coding. This result should be viewed with caution since the respondents to the

survey do not reflect general coders but individuals with some form of managerial responsibility for

coding in their employment setting. Thus, nonmanagerial coders engaged in radiology coding should be

surveyed to determine if these individuals have the same satisfaction level with continuing education

opportunities as found in this study.

As the federal government’s cost-control oversight efforts continue to increase, it is important to

understand the challenges HIM professionals face in the arena of radiology coding. Eighty-four percent (n

= 158) of the respondents reported experiencing one or more challenges related to radiology coding. Lack

of physician documentation was the top challenge (42.3 percent, n = 80), followed by keeping up with

payer rules and edits (38.6 percent, n = 73); these two challenges are common to the overall responsibility

of coding as documented in the literature.10

The third highest ranked challenge was lack of continuing


education opportunities for radiology coding (28 percent, n = 53). This finding suggests that while

respondents may be satisfied with previous continuing education and/or training related to radiology

coding, there is more need for continuing education and training opportunities in this area.

Another important challenge was access to expert radiology coders (24.9 percent, n = 47). The need

for coders in general is well documented, so it is not surprising that study respondents also identified the

need for coders in radiology.11

Many respondents indicated that their coders were responsible for a variety

of coding specializations as well as radiology coding. However, as HIM departments and professionals

assume more responsibility for radiology coding, the need for experts will continue to increase. The need

is also evidenced by an increase in the availability of certification options for radiology coders offered by

a variety of professional organizations. At the time of this writing, at least four organizations offer

specific credentials related to radiology coding that were nonexistent a decade ago (Figure 1). In addition

to these organizations, four other organizations support individuals who engage in radiology coding

through a variety of educational programming opportunities.

To address the challenges discussed above, numerous solutions have been proposed and

implemented. Offering education and training through in-service training or seminars and the use of

consultants for training were reported as helpful solutions and are also suggested by Heubusch.12

Hiring

individuals with credentials and specialization in radiology coding appears to have helped and perhaps

verifies why we are seeing growth in organizations that offer such credentials. For some, establishing a

good working relationship with physicians, radiology, and CDM departments has been helpful. In

addition, the use of software applications to confirm the medical necessity of exams has helped.

Conclusion

In conclusion, radiology coding is a specialty area of coding that has grown in importance with

increased federal regulation. It appears that HIM professionals play a role in radiology coding whether in

the actual coding of exams and procedures or in managing the function of radiology coding in general.

The responsibility for radiology coding will continue to grow along with the interest in hiring individuals

with a specialty certification in this area of practice. Although a number of organizations offer

certification in radiology coding, it may behoove the Commission on Certification for Health Informatics

and Information Management of AHIMA to implement a specialty certification in radiology coding for

three reasons: 1) to complement the credentials (RHIA, RHIT, CCA, CCS, CCS-P) of individuals

currently engaged in radiology coding; 2) to offer an option for those engaged in radiology coding who

are not yet credentialed; and 3) to further professionalize the practice of radiology coding since

credentialing demonstrates that an individual has met established standards of practice.

In addition, consideration should be given to offering continuing education opportunities to coders in

this specialty area, particularly those who are responsible for interventional radiology coding. Since this

study surveyed only members of AHIMA, it would also be of interest to survey radiology coders from

other membership or certification organizations to better understand the similarities and/or differences in

practice issues and challenges facing all coders involved in radiology coding. A limitation of the study is

that it used self-reported data; however, by expanding the study to other groups we can develop a more

global understanding of radiology coding in general. Last, the actual processes used by healthcare

providers to code radiology diagnoses and procedures should be examined to determine if work processes

influence the accuracy and quality of radiology coding.

Melanie Brodnik, PhD, RHIA, is a director and associate professor of health information management

systems at the Ohio State University in Columbus, OH.


Acknowledgments

This project was funded by the AHIMA Foundation through a generous contribution from Health

Record Services Corporation. Special acknowledgement is given to Wendy Coplan Gould, RHIA,

president of Health Record Services Corporation. We would also like to acknowledge the assistance of

Beth Friedman, RHIT, of Friedman Marketing Group.


Notes

1. Greene, M. J., and M. M. Foley. “Clinical Classification and Terminologies.” In K. M.

LaTour and S. E. Maki (Editors), Health Information Management: Concepts, Principles and

Practice. Chicago, IL: AHIMA, 2009, 347–68.

2. Casto, A. B., and E. Layman. Principles of Healthcare Reimbursement. Chicago, IL:

AHIMA, 2009.

3. Garrett, Gail. “Present on Admission: Where We Are Now.” Journal of AHIMA 80, no. 7

(2009): 22–26.

4. Johnson, Kathy M., Allison Bloom, Denise Morris, and Rod Madamba. “RAC Ready: How

to Prepare for the Recovery Audit Contractor Program.” Journal of AHIMA 80, no. 2 (2009):

28–31.

5. Department of Health and Human Services, Centers for Medicare and Medicaid Services.

Medicare Program Prospective Payment System for Hospital Outpatient Services; Final

Rule. Federal Register vol. 65, no. 68, April 7, 2000. 42 CFR Parts 409, 410, 411, 412, 413,

419, 424, 489, 498, and 1003.

6. Rangachari, P. “Coding for Quality Management: The Relationship between Hospital

Structural Characteristics and Coding Accuracy from the Perspective of Quality

Management.” Perspectives in Health Information Management 4, no. 3 (April 2007).

Available at

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_036020.html.

7. O’Malley, K., K. Cook, M. Price, K. Raiford-Wildes, J. Hurdle, and C. Ashton. “Measuring

Diagnosis: ICD Code Accuracy.” Health Services Research 40, no. 5, part 2 (2005): 1620–

39.

8. Coplan, W. News Release: Health Record Services Partners with AHIMA for Radiology

Coding Research. April 29, 2008.

9. Rode, Dan. “Summer Healthcare Forecast: Reform, ARRA Make for an Unsettled Season in

DC.” Journal of AHIMA 80, no. 7 (2009): 19–20.

10. O’Malley, K., K. Cook, M. Price, K. Raiford-Wildes, J. Hurdle, and C. Ashton. “Measuring

Diagnosis: ICD Code Accuracy.” “Measuring Diagnosis: ICD Code Accuracy.”

11. Dover, Kayce. “Keys to Finding and Retaining HIM Talent.” 2008 AHIMA Convention

Proceedings, October 2008.

12. Heubusch, K. “Coding’s Biggest Challenges Today.” Journal of AHIMA 79, no. 7 (2008):

25–28.


Appendix A

Survey Instrument


Table 1

Respondent Job Titles and Credentials

Job title Percent Frequency Department director/manager/supervisor 54.4% 143

Assistant/associate director/manager/supervisor 6.6% 18

Coding manager 37.6% 103

Billing manager 0.4% 1

Other (consultant, 4; coder, 5) 3.3% 9

Total: 276

Credential options ACS-RA (Advanced Coding Specialist-Radiology) 0.0% 0

CCA (Certified Coding Assistant) 1.1% 3

CCS (Certified Coding Specialist) 38.4% 106

CCS-P (Certified Coding Specialist-Physician-based) 6.2% 17

CIC (Certified Interventional Coder) 0.4% 1

CMC (Certified Medical Coder) 0.0% 0

CPC (Certified Professional Coder) 1.4% 4

CPC-H (Certified Professional Coder-Hospital) 1.8% 5

CPC-P (Certified Professional Coder-Payer) 0.0% 0

RCC (Radiology Certified Coder) 0.7% 2

RHIT (Registered Health Information Technician) 53.6% 148

RHIA (Registered Health Information Administrator) 35.5% 98

RN (Registered Nurse) 0.7% 2

RT(R) (Radiology Technologist-Registered) 0.0% 0

None 1.8% 5

Other 5.4% 15

Total: 276


Table 2

Examples of Credential Combinations by Respondent Job Titles

Department Director/Manager/Supervisor and

Associate/Assistant Director/Manager/Supervisor Credential or Credential

Combination Number

RHIT 69

RHIT + CCS 22

RHIT + CCS-P 3

RHIA 37

RHIA + CCS 9

RHIA + CCS-P 1

CCS 4

CPC-H 1

Coding Manager Credential or Credential

Combination Number

RHIT 15

RHIT + CCS 31

RHIT + CCS + CCS-P 2

RHIA 19

RHIA + CCS 16

CCS 17

CCS + CCS-P 6

CPC + CPC-H 1

CPC-H 2


Table 3

Employment Settings of Respondents

Employment Setting Percent Frequency Academic faculty practice 0.4% 1

Ambulatory center or clinic 1.1% 4

Billing/reimbursement company 0.4% 1

Consulting firm 2.9% 8

Healthcare vendor 0.7% 2

Hospital health information management department 82.4% 224

Hospital radiology/imaging department 0.7% 2

Hospital radiology oncology center/department 0.0% 0

Other hospital setting 4.4% 12

Imaging/radiology center (independent from hospital) 0.3% 1

Radiology oncology center (independent of hospital) 0.0% 0

Physician group practice 1.1% 3

Other 5.4% 16

Total: 272

Department or Unit Responsibility Percent Frequency Facility radiology coding 63.7% 174

Physician practice radiology coding 0.7% 2

Both facility and physician practice radiology coding 8.1% 22

No radiology coding 27.5% 75

Total:: 273


Table 4

Number of Coders per Site

No. of

Coders

per Site

Frequency

<1 15

1 57

1.5 7

2 36

2.5 3

3 14

3.5 2

4 7

5 4

6 3

6.5 1

7 3

8 2

10 3

11 1

12 1

13.5 1

23 1

30 1

97 1


Table 5

Credentials of Coders

Credential Options

Response

Percent

Response

Count

No. of FTE

Coders with

Credential ACS-RA (Advanced Coding Specialist-Radiology) 1.8% 3 1

CCA (Certified Coding Assistant) 12.3% 21 25

CCS (Certified Coding Specialist) 39.2% 67 124

CCS-P (Certified Coding Specialist-Physician-based) 9.9% 17 25

CIC (Certified Interventional Coder) 2.3% 4 8

CMC (Certified Medical Coder) 1.8% 3 1

CPC (Certified Professional Coder) 18.1% 31 61.5

CPC-H (Certified Professional Coder-Hospital) 7.0% 12 29.5

CPC-P (Certified Professional Coder-Payer) 1.2% 2 0

RCC (Radiology Certified Coder) 2.3% 4 3

RHIT (Registered Health Information Technician) 53.8% 92 230.75

RHIA (Registered Health Information Administrator) 17.0% 29 35

RN (Registered Nurse) 3.5% 6 3

RT(R) (Radiology Technologist-Registered) 2.9% 5 4

Other (please specify) 15.2% 26 -

Totals: 322 550.75

answered question 171


Table 6

Type of Radiology Report or List Used for Coding

Report or List Percent Frequency Individual radiology reports 69.1% 134

Lists of radiology procedures 1.5% 3

Combination of both 13.4% 26

Other 16.0% 31

Total: 194


Table 7

Coding Roles by Exam Type

Type of

Radiology Exam Codes

only dx Codes only

CPT proc.

Codes dx

and CPT

proc.

Codes

dx and

CM

code

proc.

Adds

modifiers to

CPT proc. Don’t

code Not

sure Frequency

Diagnostic 115 3 48 33 60 9 1 193

Ultrasound/

nuclear 114 4 42 32 56 11 1 189

MRI/CT 112 5 40 34 53 10 2 189

Interventional 51 6 104 33 77 16 3 185

Mammography 110 5 37 25 49 19 1 186

Other 23

answered question 198


Table 8

Productivity Standards for Radiology Coding from Reports and Lists

Exam Type - Reports Percent Frequency Range Std/hr Standard for all exam reports 25.8% 39 10 to 60 24

Diagnostic 16.6% 25 10 to 85 31

Ultrasound/nuclear 13.2% 20 10 to 60 27

MRI/CT 14.6% 22 6 to 60 26

Interventional 20.5% 31 2.5 to 15 7

Mammography 12.6% 19 10 to 70 28

Other 16.0% 25

No standards required 41.1% 62

answered questions 151

Exam Type - Lists Percent Frequency Range Std/hr Standard for all exam lists 6.8% 6 20 to 40 28

Diagnostic 5.8% 5 20 to 40 29

Ultrasound/Nuclear 4.6% 4 20 to 40 29

MRI/CT 4.6% 4 20 to 40 29

Interventional 3.4% 3 3.3 to 40 21

Mammography 5.7% 5 20 to 60 35

No standards required 69.0% 60

answered questions 87


Table 9

Satisfaction with Continuing Education Opportunities

Answer Options Percent Frequency Extremely satisfied 6.1% 12

Very satisfied 14.7% 29

Satisfied 48.7% 96

Dissatisfied 16.2% 32

Very dissatisfied 0.5% 1

Not aware of continuing education programs or training in radiology coding 13.7% 27

Total: 197


Table 10

Radiology Coding Challenges

Challenges Percent Frequency 1. Lack of physician documentation 42.3% 80

2. Keeping up with payer rules and edits 38.6% 73

3. Lack of continuing education opportunities in radiology coding 28.0% 53

4. Access to expert radiology coders 24.9% 47

5. High volume of work 21.7% 41

6. High level of denied claims for medical necessity 12.7% 24

7. Inability to query physicians 13.2% 25

8. Difficult relationships between departments 12.7% 24

9. Inadequate training of personnel who code 9.0% 18

None 16.4% 31

Other 5.5% 11

answered questions: 189


Figure 1

Coding Certification Organizations

Organizations Offering

Radiology Coding Certifications

Organizations Offering Coding Certifications

American Academy of Professional Coders

o Certified Interventional Radiology

Cardiovascular Coder (CIRCC)

Board of Medical Specialty Coders

o Advanced Coding Specialist –

Radiology (ACS-RA)

Medical Asset Management, Inc.

o Certified Interventional Coder (CIC)

Radiology Coding Certification Board

o Radiology Certified Coder (RCC)

American Academy of Professional Coders

o Certified Professional Coder (CPC)

o Certified Professional Coder-Hospital (CPC-H)

o Certified Professional Coder-Payer (CPC-P)

American College of Medical Coding Specialist

o Physician Coding Specialist (PCS)

o Facility Coding Specialist (FCS)

o Coding Specialist for Payers CSP

American Health Information Management Association

o Certified Coding Associate (CCA)

o Certified Coding Specialist (CCS)

o Certified Coding Specialist-Physician-based

(CCS-P)

Practice Management Institute

o Certified Medical Coder (CMC)

Exploratory Study of Radiology Coding in Health...

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