UnitedHealthcare's (UHC) new cardiovascular and radiology imaging guidelines go into effect October 21 for specific radiology programs.
The changes address numerous coding issues and will impact Medicaid community plans, UHC commercial plans, exchange plans, Medicare Advantage, and dual special needs plans, according to the organization.
UHC noted overutilization in many areas of advanced imaging and other procedures, including high-level testing without consideration of less invasive and lower-cost options, excessive radiation, costs with unnecessary testing, and defensive medical practice.
Radiology administrators and billing teams will find several lengthy documents that outline, for example, appropriate and inappropriate coding for numerous imaging studies, coding for 3D rendering in relation to independent workstations for postprocessing, and the proper way to bill an MRI-guided breast biopsy.
The new payer guidelines also include how to use certain codes per individual encounter, use of unlisted procedure codes, and use of quantification tools.
Review the changes here.
