In diagnostic and interventional radiology revenue cycle management, the coding stage can often be one of the single greatest points of failure for a practice’s financial health. Groups are focusing more than ever on increasing patient volume to drive growth, and rightfully so. However, a key component of growth that is often missed and easy to achieve is ensuring you are maximizing collections on the procedures you already provide. According to the latest Accounts Receivable Survey conducted by the Radiology Business Management Association, hospital-based radiology groups typically do not receive payment for 1 of every 6 procedures performed, meaning the average group is leaving 16% of their hard earned money on the table. One of the best paths to profitability lies in revenue integrity. This process needs to start with radiology groups ensuring that every procedure performed is documented accurately, coded precisely, and reimbursed fully.
At Dexios, we provided complimentary billing analyses to radiology practices nationwide, and we have seen firsthand how radiology practices are often hemorrhaging revenue. There are many factors that can cause this revenue shortfall, but one that is easy to fix is by repairing systemic coding inefficiencies. Below, we explore the primary drivers of revenue loss in coding and how a specialized, hands-on approach from experienced, radiology-specific coding staff, paired with an AI-enhanced approach, can transform your bottom line.
1. The High Cost of the "Generalist" Approach
Medical coding is often treated as a commodity, but in radiology, it requires a level of precision that general medical coders frequently struggle to maintain. Unlike other specialties that center on routine office or wellness visits, radiology is a high-volume field where coders must navigate a larger range of modalities. Each specific modality carries its own distinct set of coding rules and documentation requirements that must be applied across patients of all ages, from neonatal to geriatric cases.
Because radiologists do not follow the standard "template" of a typical office visit, coders must act as expert extractors, meticulously pulling key clinical elements and anatomical details from complex narratives. Within the radiology realm, the coder is responsible for mastering the nuances of every single modality and procedure type; misinterpreting a radiologist’s note can lead to "under-coding," where complex work is billed at a lower level, or "over-coding," which triggers audit risks and costly recoupments. This is especially true in Interventional Radiology (IR), which demands a deep understanding of vascular anatomy and catheter placements to ensure every component of the procedure is captured accurately.
It is easy to make direct changes to combat this issue. For example, at Dexios, our coders are experts in radiology, meaning they don’t just read the report; they understand the procedure. For example, our Coding Supervisor started as an X-ray technologist, so her foundation is clinical. This clinical mindset of our coders allows us to identify documentation deficiencies, the gap between what the radiologist did and what they wrote, enabling us to provide feedback that improves clinical documentation at the source. Dexios also employs Radiology Certified Coders in IR (RCCIR) and Certified Interventional Radiology Cardiovascular Coders (CIRCC), who are specialists who code our IR procedures to ensure these high-dollar procedures are coded accurately. Our E&M coding is handled with the same level of attention by a specialist who understands the nuances of coding non-procedural patient encounters. Therefore, specialization, expertise, and a clinical mindset are the keys to successful radiology coding.
2. Breaking the "Production-Only" Silo
In many large-scale billing companies, coders are incentivized solely by production volume. Once a claim is coded, it is sent "over the wall" to a separate denials team. When coders are disconnected from the denial feedback loop, they lack visibility into changing payer behaviors. If a specific payer begins requiring a new modifier or changes their preference. For example for "LT" and "RT" indicators, a production-focused coder will continue making the same error across thousands of claims before the denials team notices a trend.
However, when coders are responsible for working on their own denials like at Dexios, it naturally creates a continuous learning loop. By seeing why a claim was rejected, our coding team gains real-time insight into specific payer preferences. This proactive "whole picture" view ensures that we aren't just coding for today, but optimizing for a lower denial future.
3. Navigating Regulatory and Payer Complexity
The regulatory landscape for radiology is in a state of constant flux. From updates in the Medicare Physician Fee Schedule to the nuances of the No Surprises Act, staying compliant while maintaining speed is a delicate balance. In-house coding teams, especially in smaller practices, often lack the bandwidth to keep up with these shifts. This often leads to "safe" coding, where teams intentionally under-code to avoid the risk of denials, inadvertently leaving thousands or even millions in unclaimed revenue on the table.
At Dexios, our specialization is our superpower. Because we focus exclusively on radiology, we are hyper-focused on its specific regulatory changes. We don’t just wait for updates to reach us; we are deeply embedded in the radiology coding community. Our team maintains active memberships and stays current through the Radiology Business Management Association (RBMA) and regularly attends industry-leading webinars and conferences to stay ahead of payer shifts.
We also pride ourselves on learning from the best in the business. We maintain close partnerships and engage in ongoing education with industry titans like Dr. Z and Stacie Buck of RadRx. By leveraging these high-level expert resources, we ensure our coding logic is sound. We manage the complexity so our radiologists and practice managers don't have to, ensuring that your practice remains compliant without sacrificing legitimate reimbursement.
4. Documentation Issues
A code is only as strong as the documentation supporting it. If a report is incomplete, you aren't just risking a denial, you are essentially leaving money on the table for work already performed. Many billing companies take a passive approach, "down-coding" a claim to a lower level of reimbursement when documentation is thin rather than addressing the root cause.
At Dexios, we take an active role in documentation integrity. We don’t just code what is there; we identify what is missing. Our team is highly skilled at identifying requirements for National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) to ensure full payment. For example, if a radiologist performs a CTA of the Thorax but omits the required 3D documentation, we don’t simply down-code the procedure. Instead, we send the report back to the physician to be corrected, ensuring the practice receives the full reimbursement it earned.
To ensure this isn't a one-time fix, we provide our radiologists with a continuous feedback loop every two weeks. This regular communication educates physicians on specific payer requirements and documentation components, improving the quality of the reports at the source. We even assist with building out optimized radiology report templates to make comprehensive documentation a seamless part of the clinical workflow.
5. Balancing the Use of Technology
The traditional manual coding model is increasingly unsustainable due to rising labor costs and the scarcity of qualified coders. However, pure AI solutions often lack the nuance to handle complex cases, such as Interventional Radiology or other complex modalities. The overuse of AI can be seen in larger generalized billing companies that pride themselves on their level of automation but lack the manpower to maximize collections and go after every dollar, which is why their clients have lower collections.
When looking for an AI coding solution, Dexios vetted potential partners thoroughly, seeking to ensure that the solution improved coding accuracy and speed, reduced costs for our clients, and could handle industry-wide changes with no downtime for continual rule-based calibration. Insert Dexios AI Cloud Coding, which is powered by Maverick Medical AI. This coding solution is not just automation; it is a hybrid intelligence model.
Maverick’s deep learning, powered by transformers and neural networks, achieves an industry-leading 65% direct-to-bill rate for our clients reporting/coding MIPs and 85% direct-to-bill rate for those that do not. This tool eliminates the human error in high-volume, repetitive procedures. For any procedure for which AI is not confident in its accuracy, Dexios provides a human safety net through having our expert radiology coders review the AI coding and ensuring its accuracy. Our expert coders audit the AI’s output and manually handle the remaining percentage of complex or interventional cases that require human judgment. Our coding team also randomly selects codes that the AI solution is confident in for manual auditing to ensure continual checks on the solution's accuracy. This hybrid approach significantly reduces operational expenses while accelerating the billing cycle. Our clients can get the speed of a machine and the accountability of a certified professional.
Turning Your Radiology Coding Stage into a Competitive Advantage
Revenue loss in the coding stage is not inevitable. It is a symptom of fragmented processes and a lack of specialization. By combining clinical expertise, a closed-loop denial management system, and the industry’s most advanced AI platform, Dexios ensures that your radiology practice isn't just surviving the current healthcare landscape, but thriving in it.
Is your practice ready to plug the leaks? Contact Dexios Today for a free billing analysis today.