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Coding and Reimbursement Issues for the Radiologist¹

¹ From the Department of Radiology, University of Virginia Health System, Box 800170, Charlottesville, VA 22908. Received December 6, 1999; revision requested January 21, 2000; revision received July 6; accepted July 14; updated February 8, 2001. Address correspondence to C.D.P. (e-mail: cdp9m@virginia.edu).

Radiologists are dependent on the proper execution of a complex administrative chain of disease and diagnosis coding and procedural coding to be properly reimbursed for the examinations they perform. The radiologist bears the ultimate responsibility for the appropriateness of these codes. However, many practicing radiologists are unaware of the critical link between the two coding systems and the systems that have developed to provide a common method of describing diseases, diagnoses, and procedures. This article is an introduction to these systems, and it emphasizes the importance of the involvement of the radiologist in coding. The inherent complexity of the reimbursement system in use is emphasized, as well as the essential role of the radiologist in complying with these often complicated and ever-changing directives.

Index terms: Cost-effectiveness • Radiology and radiologists, departmental management • Radiology reporting systems