Common Radiology Billing Errors and How to Avoid Them

Most Common Radiology Billing Mistakes and How to Prevent Them

Radiology billing is generally considered merely another administrative function, but minor errors result in substantial revenues lost, compliance fines, or payment postponement. With multiple CPT codes that are distinct, numerous modifier applications, payor-specific guidelines, and stringent documentation requirements, radiology billing ranks among the most error-laden portions of the healthcare revenue cycle.

This handbook summarizes the most common radiology billing mistakes—derived from industry statistics and audit reports—and delivers practical solutions to prevent them.

1. Misuse of Modifiers

Modifiers play a key role in radiology billing to establish the extent of services—like whether a claim involves the professional or technical component. The two most frequently misapplied are:

Modifier -26 (professional component)

Modifier -TC (technical component)

A frequent mistake is when a radiologist charges for the entire global service if only the interpretation was carried out. This results in duplicate payments or denials.

How to Avoid It:

Make sure your RIS or EHR system is set up to properly record site-of-service information. Coders should ensure if the equipment belongs to the radiology group or facility and if the radiologist is interpreting exclusively. Real-time coding hints from tools like AAPC Coder can also minimize the possibilities of improper modifier usage.

2. Upcoding or Underbilling Due to Gaps in Documentation

Occasionally, radiologists do extra work (e.g., 3D reconstruction, contrast studies), but it's not documented. This results in:

Underbilling, where potential income is lost

Or worse, upcoding, where a high-value code is submitted without documentation

How to Avoid It:

Make your radiology report forms coincide with CPT code descriptions. Have radiologists trained to report on all facets of the examination clearly, such as using contrast, imaging method, body parts, and clinical observations.

3. Unbundling of Procedures

A few radiology services are categorized as part of a bundled code, which should not be billed independently. Certain imaging guidance codes, for instance, are included in biopsy CPTs.

Separately billing these services is referred to as unbundling, which is an auditor's flag of warning.

How to Avoid It:

Use the NCCI edits checker to find bundled services. These edits are released quarterly by CMS and available online through coding websites or integrated into your billing program. Coders should also check payer-specific bundling policies on audits.

4. Inaccurate or Absent ICD-10 Codes

Billing the proper CPT code isn't sufficient—the diagnosis (ICD-10) code must support medical necessity. Radiology claims are often denied when:

The ICD-10 code does not correspond with the test requested

Vague or missing reason for the scan

Symptom code is applied if there is an explicit diagnosis

Prevention:

Ensure referring physicians are educated to give full clinical indications when writing orders. Employ decision-support tools at the time of scheduling that identify weak or unsupported diagnosis codes. An efficiently managed ICD-10 library, radiology-specific, assists in preventing vague inputs.

5. Missing or Expired Authorizations

Advanced imaging procedures such as CT, MRI, and PET usually need prior authorization. Not getting or renewing this prior to the exam results in full claim denial.

How to Prevent It:

Implement automated prior auth and eligibility software that follows payer mandates. Front-desk staff should confirm and record auth numbers during scheduling. You can also implement scrapping tools for payer portals to check auth status, minimizing manual effort (Radiology Business Journal).

6. Billing the Wrong Provider or Facility

Radiology services can be shared between multiple facilities and providers, and it is simple to misbill:

Under the wrong NPI

From the incorrect service location

With the wrong TIN (Tax ID) for payment

How to Avoid It:

Optimize your billing software with verified provider and facility master lists. Claims must be auto-populated from the RIS/PACS data, and double-checked when submitting. All staff should be aware of the global vs. split billing model, particularly when it comes to multiple locations.

7. Lack of Capturing All Billable Elements

Radiology reports frequently include add-on services such as 3D rendering, contrast administration, or extra views—but they may go unbilled if not separately coded.

How to Prevent It:

Review your CPT code utilization quarterly and look for underused codes. Contrast use and the fact that an extra body part was imaged need to be clearly reported by trained radiologists. Utilize structured templates that remind radiologists to check these elements.

8. Timely or Inept Denial Follow-Up

Even clean claims get denied from time to time. Yet many groups of radiologists do not have the staff or procedure to:

Quickly identify reasons for denial

Appeal within timely filing limits

Recover underpaid or short-paid claims

How to Avoid It:

Use a denial management workflow that differentiates technical denials (e.g., format issues) from clinical ones (e.g., lack of documentation). Numerous high-performing radiology billing partners include denial resolution as a main service. See this handpicked list of best radiology billing firms specializing in denial tracking, payer negotiation, and clean claim optimization.

9. Failure to Keep Up with Evolving Regulations

Regulations like PAMA, the No Surprises Act, and Appropriate Use Criteria (AUC) have significant implications for radiology billing. Ignoring them can result in:

Reduced reimbursements

Penalties for balance billing

Lost eligibility for Medicare claims

How to Avoid It:

Stay updated using tools like CMS AUC Program Updates. Designate a compliance officer or outsource to a billing firm with regulatory expertise. Training sessions and policy alerts should be part of your monthly workflow.

Conclusion

Radiology billing mistakes—although prevalent—are preventable with the proper processes, technology, and education. Practices that are proactive with audits, documentation improvement, and regulatory training can decrease denials, increase revenue, and remain compliant.

If your practice is facing any of the above difficulties, then it may be time to look at billing partners who have extensive radiology expertise. You can begin by checking out this list of top-performing radiology billing vendors that have established compliance processes and clean claim assistance.

Appendix: References

AAPC Coder Tools: https://www.aapc.com/codes

CMS AUC Program: https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/appropriate-use-criteria-program