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.
2. 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.
3. Prior Authorization Issues
Many advanced imaging studies (MRI, CT, PET) require prior authorization.
Failure to obtain pre-approval results in automatic denial.
How to Reduce Denials?
Double-check coding (CPT, ICD-10, modifiers).
Verify medical necessity with ACR Appropriateness Criteria.
Ensure prior authorization is obtained when required.
Audit claims before submission.
For more: https://annexmed.com/best-prac....tices-for-radiology-
