IR Billing — Image-Guided Procedures, Billed Right

Proven Results

• 35.5% Average Revenue Increase
• 94.2% First-Pass Claim Rate
• 44.2% Reduction in Denials
• 18.2 Days Faster Payment Collection

Common Billing Challenges

Complex Procedure Coding

Interventional Radiology procedures require precise CPT coding for diagnostic tests, interventional procedures, and device implantations.

Prior Authorization Delays

Cardiac procedures often require extensive prior authorizations, causing treatment delays and administrative burden.

High-Value Claim Denials

Cardiac procedures are high-value, making denials particularly costly for practice revenue.

Global Period Management

Managing global periods for surgical procedures and avoiding bundling issues with follow-up care.

Device & Implant Billing

Complex billing for pacemakers, defibrillators, and other radiology devices with specific coding requirements.

Multiple Payer Requirements

Different insurance companies have varying requirements for radiology procedure documentation and coding.

Our Solutions

Interventional Radiology-Certified Coders

Our team includes certified coders with specialized training in cardiovascular procedures and coding.

• Accurate CPT and ICD-10 coding for all radiology procedures
• Expertise in interventional interventional radiology billing
• Knowledge of device-specific coding requirements
• Reduced coding errors and claim denials

Prior Authorization Management

Dedicated team handles all prior authorization requirements for radiology procedures and diagnostics.

• Faster approval times for urgent procedures
• Reduced administrative burden on clinical staff
• Higher approval rates through proper documentation
• Streamlined patient scheduling process

IR Procedure Revenue Capture

Ensure proper billing for the technical and professional components of image-guided interventional procedures.

• Correct component billing for combined diagnostic and interventional angiography
• Catheter placement and selective vessel coding with proper supervision levels
• Device and implant billing for embolization coils, stents, and filters
• Image guidance supervision and interpretation split billing optimization

Interventional Radiology Analytics

Track procedure mix, device costs, and payer reimbursement patterns specific to IR practice operations.

• Procedure-level cost analysis accounting for device and supply expenses
• Payer reimbursement comparison for high-volume IR CPT codes
• TC/PC split billing accuracy monitoring across facility and office settings
• Prior authorization turnaround tracking for elective IR procedures

Specialized Services

Diagnostic Interventional Radiology Billing

Expert billing for EKGs, echocardiograms, stress tests, and radiology catheterizations.

• EKG interpretation billing
• Echo and stress test coding
• Holter monitor billing
• Nuclear interventional radiology procedures

Interventional Procedures

Specialized billing for angioplasty, stent placement, and other interventional procedures.

• PCI procedure coding
• Stent and device billing
• Balloon angioplasty
• Atherectomy procedures

Device Implantation

Complex billing for pacemaker, ICD, and CRT device implantations and follow-ups.

• Pacemaker implantation
• ICD placement and programming
• CRT device billing
• Device interrogation

Electrophysiology

Specialized billing for EP studies, ablations, and arrhythmia management.

• EP study billing
• Catheter ablation procedures
• Arrhythmia monitoring
• Loop recorder implantation

Common CPT Codes Reference

Key codes include 36247 (Selective catheter placement, third-order or higher, initial), 37220 (Revascularization, endovascular, iliac artery, single vessel), 37228 (Revascularization, tibial or peroneal artery, open or percut), 37242 (Transcatheter therapy, embolization, arterial, other than he), 37243 (Transcatheter therapy, embolization, organ-preserving), 75710 (Angiography, extremity, unilateral), 49505 (Repair initial inguinal hernia, age 5 or older, reducible), 20206 (Biopsy, muscle, percutaneous needle), 49440 (Insertion of gastrostomy tube, percutaneous, under fluorosco), 75809 (Shuntogram). Proper code selection requires understanding of bundling rules, NCCI edits, and modifier usage.

Expert Billing Insights

Catheter Hierarchy Rules: Selective and Non-Selective Placement Coding

Arterial catheter placement coding follows a hierarchical system based on the order of selectivity. Non-selective placement (aorta, IVC, main vessels) uses lower-value codes; first-order selective (main branch from aorta), second-order (branch off first-order), and third-order or higher selective placement use progressively higher-value codes. When an IR physician places a catheter selectively in a vessel family, only the highest-order code is billed — not all catheter positions reached along the way. Understanding vascular anatomy and "vessel families" is essential for accurate catheter coding.

• Bill only the highest-order catheter placement achieved within each vessel family
• Different vessel families (celiac, SMA, SMA branches) can be billed separately if all accessed
• Non-selective aortography: 75625; selective renal angiography: 75724 + selective catheter code
• Document: vascular access site, catheter tip position at each selective position, and contrast used

Peripheral Vascular Intervention Coding: Zone-Based System

The 2011 revascularization code changes introduced a zone-based system for lower extremity peripheral arterial intervention coding. Iliac (37220/37221), femoral-popliteal (37224/37225), and tibial (37228/37229) zones each have distinct primary and add-on codes based on whether angioplasty, stent, or atherectomy was performed. Within each zone, multiple vessel interventions use add-on codes. The zone system requires careful mapping of each treated vessel to the correct zone and intervention type.

• Iliac zone: 37220 (initial), 37221 (additional); fem-pop: 37224 (initial), 37225 (additional)
• Document each vessel treated, intervention type (PTA, stent, atherectomy), and outcome
• Atherectomy codes (37225, 37229): separately reportable when performed in addition to PTA
• Stent codes include angioplasty — do not separately bill PTA when stenting the same vessel

Tumor and Organ Embolization Billing: Chemoembolization and UAE

Transcatheter arterial embolization procedures for hepatocellular carcinoma (TACE/TARE), uterine fibroid embolization (UFE/UAE), and hemorrhage control each have specific CPT codes. Transarterial chemoembolization (TACE) uses 37243 with modifier and documentation of the chemotherapy agent used. Y90 radioembolization (TARE) has a combination of IR procedure codes plus nuclear medicine treatment codes. Prostate artery embolization (PAE) for BPH is coded with 37243 and requires specific clinical documentation for payer coverage.

• TACE (hepatocellular): 37243 + appropriate chemotherapy/drug documentation
• Y90 TARE: 37243 (IR component) + 79445 (nuclear medicine Y90 administration)
• UFE/UAE: 37243 (bilateral usually) — document both uterine arteries embolized
• PAE for BPH: 37243 — document clinical criteria (BPH symptoms, failed medication) in record

Payer-Specific Billing Tips

Medicare

• IR procedures have varying global periods: 0-day (diagnostic/minor), 10-day (moderate), 90-day (major)
• UFE/UAE: Medicare covers for symptomatic uterine fibroids with documentation of failed medical management
• TIPS procedure: covered for portal hypertension with variceal bleeding or refractory ascites
• Peripheral arterial interventions: Medicare PAD coverage requires documented ABI and symptom severity

Medicaid

• IR procedures typically require prior authorization under state Medicaid managed care plans
• TACE and tumor embolization: prior auth with oncologist documentation of tumor board decision
• Medicaid coverage for PAE (prostate artery embolization) is limited — verify before scheduling
• Pediatric IR procedures: EPSDT covers medically necessary interventional procedures

Commercial Payers

• All IR procedures require prior authorization — submit with imaging and clinical justification
• UFE: prior auth requires failed medical management documentation; prior GYN evaluation required
• Tumor embolization: multidisciplinary tumor board documentation supports authorization
• Y90 radioembolization: strict coverage criteria vary by plan; include dosimetry and eligibility documentation

IR Billing Compliance

• Unbundling: do not bill supervision and interpretation (S&I) codes that are included in intervention codes
• NCCI edits restrict certain catheter and intervention code combinations — use unbundling modifier correctly
• Document all medications used in the procedure (contrast, heparin, vasodilators) for cost reporting
• TIPS, TACE, and complex IR cases: ensure peer-to-peer when prior auth is denied — high clinical impact

Key Services

• interventional radiology billing
• IR billing services
• minimally invasive procedure billing
• image-guided billing