Radiology Coding Alert

Question: Do the radiology techs need to obtain a new order from referring physicians if they are not doing a bilateral diagnostic mammogram but are instead performing a follow-up on the side that had a previous abnormal finding?

Minnesota Subscriber

Answer: There are different guidelines within the Medicare Benefit Policy Manual (Chapter 15, Section 80.6) surrounding changes to diagnostic testing depending on whether the testing is performed in a hospital/outpatient setting or at an independent diagnostic testing facility (IDTF). However, in the case of the example provided, both guidelines will advise that the patient obtains a brand-new order for the change from a bilateral to a unilateral diagnostic mammogram.

Section 80.6.2 states that, “when an interpreting physician at a testing facility determines that an ordered diagnostic radiology test is clinically inappropriate or suboptimal, and that a different diagnostic test should be performed, the interpreting physician/testing facility may not perform the unordered test until a new order from the treating physician/practitioner has been received.”

In an IDTF, the provider does have the authority to change various parameters of a particular exam (only if left unspecified in the order), but these parameters do not include a revision from a bilateral to a unilateral exam (or vice versa). Rather, these parameters include changes to “number of radiographic views obtained, thickness of tomographic sections acquired, use or non-use of contrast media.”

Additionally, in an IDTF, the provider has the authority to modify any “clear and obvious” errors without notifying the referring provider. This includes changes mistakes involving laterality (i.e., right leg to left leg). However, even if the referring provider made a clear mistake in ordering a bilateral mammogram over a unilateral mammogram, this is likely not enough of a glaring error to proceed without a new order.