done to optimize Epic for IR in terms of appointment schedules, clinic visits and E/M coding.


“If you’re lucky to have an IR chief, they can commit some administrative time optimizing Epic. Otherwise, each individual IR physician must spend human time doing computer work,” Dr. Gueyikian said.


However, there are hundreds of home- grown workfl ows in Epic—many of which may be in use in a diff erent department at an IR’s home institution.


There are now specifi c code sets that help IRs and other clinical physicians capture E/M work that happens in a virtual space.


do not have the time to look at requests or evaluate new patients, because it is so time consuming, and there’s no reimbursement,” Dr. Gueyikian said.


So, the question is, how do you convert that work into something that is documented, as well as billable?


Learning the codes Historically, an IR consult would involve meeting the patient in person to discuss a treatment plan. This workfl ow is well-established and has a billable code. However, hospitals are increasingly dealing with patients that are spread across large geographic areas, and there aren’t enough IRs to meet the demand for in-person consults.


“Now, you are seeing the virtual representation of the patient, which is their chart,” Dr. Gueyikian said. “You can get almost all the information you need from a chart, without meeting the patient. That didn’t used to be billable work, but now it is.”


There are now specifi c code sets that help IRs and other clinical physicians capture E/M work that happens in a virtual space.


“There are rules around them,” Dr. Gueyikian said. “You must have the patient’s permission for telemedicine work, for example, and you cannot use certain codes multiple times within


20 IRQ | WINTER 2026


a certain period of time for the same patient. And if you’re going to do a procedure on this patient, you may not be able to collect on certain codes because you’ll be seeing them in-person within a week.”


Learning these codes is diffi cult, especially as many IRs were not taught about E/M billing during their training. Finding reputable, IR-focused resources can also be a challenge, which is why many IRs are forced to learn on the job.


Dr. Gueyikian said most of his on-the- job training has come from resources provided by SIR, such as the Coding Academy or the SIR Business Institute. But he has also learned a lot from other specialties who are better versed in capturing this work.


“Speaking to my colleagues in other specialties has been extremely eye- opening,” he said. “I realized that the tools they use in Epic have been built specifi cally for them, and it makes this work so much easier if you can fi nd a way for those tools to be brought into your Epic world.”


Optimizing your system According to Dr. Gueyikian, the fact that IR is a “hybrid specialty” that does both consults and clinical work makes it diffi cult for many systems to have an out-of-the-box solution, and there is a lot of manual work that has to be


Dr. Gueyikian has built a series of templates himself, which feature pre- built notes that will automatically pull in patient information and generate the note. Each template is designed to ensure information is captured and associated with the correct code, so that his partners wouldn’t need to worry if they were missing out on something crucial for reimbursement.


“There is always a fear that you’ve forgotten the magic phrase to collect reimbursement,” Dr. Gueyikian said. “So, as part of our audit review with our billing company, we submitted several of these reports to see if they were billing correctly, and they were.”


Selecting an appropriate billing service is also crucial, Dr. Gueyikian said, as traditional radiology billing companies are not often well versed in E/M coding.


“One solution is to have part of your volume go through a radiology billing company but have the E/M coding go through a clinically based billing company,” he said.


It can be a challenge to relearn a new way to use Epic, especially for those who have been using it for decades. But Dr. Gueyikian believes that the eff ort is all worth it.


“If you can properly utilize the codes and technology at your disposal, it means you will have better documentation, reliable reimbursement, and more time available to dedicate to patient care.”


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