In a previous article we opined that the days of charging “piece meal” for radiographs (e.g. set up fee, additional projections, etc.) have gone the way of the horse and buggy, cell phone without a full keyboard, and vet practice making money off of flea products . Our recommendation is that veterinarians start charging by the study rather than the piece of x-ray film. The main reasons for charging by the study and not by the image are:
- With digital radiography there is no significantly increased cost for charging for an extra image as there are few repeats and the hard cost for obtaining a single image vs. a study is the same.
- It is better medicine to charge by the study as indications for a single view of anything are few and far between
- Charging by the study paves the way for automated billing and practice management integration.
Assuming that you buy our premise that charging by the image is so 1981 and getting with the times is the way to go, implementing a per study billing scheme is easy if you keep it simple. Our recommendation is to have 9, and only 9, billing charges for radiology. These are
- 1 view study:
- to be used sparingly in STAT cases for animals that were hit by cars or for bladder screenings to check for calculi in blocked cats
- 2-view study
- to be used any time 2 images are obtained (e.g. thorax, abdomen, single region of the spine, stifle joint, pelvis, etc)
- 3- view study
- to be used primarily with a 3 view thoracic metastatic screening
- spine survey - survey spine images will have loads of images. Take as many as you like but have one charge
- skull – skull radiographs are always a pain in the rear and require general anesthesia. Repeats for positioning are common and unavoidable. Charge for them.
- barium GI series1
- cystogram1
- myelogram1
- urethrogram1
- esophagram1
At this point, it is probably worth mentioning that the charges in practice management software correlate to studies that are done in the radiology room. I do not, however, recommend that there are only 9 different study types in your digital radiography system. For purposes of the digital radiography system, there can (and should) be numerous different study types but each one of these types is correlated to a single billing code of which there are only nine.
Examples of digital radiography study types and their correlated billing code are:
- 2 view thorax (2 view study billing code)
- 3 view thorax (3 view study billing code)
- 2 view stifle series (2 view study billing code)
- 2 view tarsus series (2 view study billing code)
- whole body (2 view study billing code)
- 2 view foot evaluation (2 view study billing code)
- Lumbar spine evaluation (2 view study billing code)
- GI series (Barium GI series)
Currently, every veterinary practice calls their digital radiography study types by a different name and there are loads of different types of studies that are performed in veterinary practices. It would be great if as an industry, we could standardize the digital radiography study types as this is an essential step in facilitating automated billing between practice management vendors and the digital radiography vendors. I will take a stab at my suggestions for studies that should be included in a digital radiography system but that is a story for another day.
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1. Call me a cynic but these are really the only contrast procedures that have much value. Barium enemas? BIPS? Please no.