Radiology: Watch For OIG Scrutiny Of Imaging Claims

Why This Topic Matters

Imaging services have been a focus of utilization review and claim scrutiny, so radiology practices need to understand the compliance and billing issues highlighted here. The article is relevant to anyone responsible for coding, ordering, scheduling, or reviewing advanced imaging claims.

Article Sections

1. OIG scrutiny of imaging utilization

   An overview of federal interest in growth trends for advanced imaging services and the resulting attention on Medicare claims. The section frames why radiology practices are being monitored more closely.

2. Screening mammograms

   A discussion of a screening mammography scenario involving a unilateral study and the related billing and diagnosis-reporting considerations. The section focuses on a common radiology claim question.

3. Keep V72.5 on the back burner

   Guidance on selecting a diagnosis code when an x-ray is ordered without a clear presenting reason. The section emphasizes the importance of obtaining the ordering diagnosis and understanding routine-exam circumstances.

4. DEXA scans

   A billing scenario involving multiple bone density studies in the same encounter and the claim-processing concerns that may follow. The section covers how payers may review the services and whether additional follow-up may be needed.