Expert Radiology Billing Services by AnnexMed

submitted 1 week ago by charlesmurphy to health

The most common reason for radiology billing claim denials is missing or incorrect information, particularly related to coding errors and documentation issues. Here are the top specific reasons:

1. Incorrect or Missing Modifiers Radiology procedures often require specific modifiers (e.g., -26 for professional component, -TC for technical component, or -LT/-RT for laterality).

Omitting or misusing these leads to denials.

1. Lack of Medical Necessity Payers (especially Medicare and private insurers) require appropriate ICD-10 codes that justify the imaging study.

If the diagnosis code doesn’t align with payer policies (e.g., Local Coverage Determinations (LCDs)), the claim is denied.

1. Prior Authorization Issues Many advanced imaging studies (MRI, CT, PET) require prior authorization.

Failure to obtain pre-approval results in automatic denial.

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