Radiology Coding Alert

Question: The X-ray tech gets an order for a chest X-ray for two views, however when the patient comes in for the X-ray, the tech has to take three or four due to the patient's size. Does she send a message to the ordering provider for a new order? Does she change the CPT® code? All I can find is that the new codes are based solely on the number of views, so we just want to know if the tech needs to contact the ordering provider for a new order in these instances.

Mississippi Subscriber

Answer: Radiology techs do not have the authority to change the order or exam performed. The provider, however, does have the authority under certain conditions. For example, if the order does not specify number of views or with/without contrast, then these variables can be left up to the provider's discretion.

However, the provider should never make a change from one radiology test to another without authorization from the ordering physician. For example, if the radiologist determines that a computerized tomography (CT) scan will provide suboptimal imaging for the patient's condition, he or she cannot make the change to a magnetic resonance imaging (MRI) scan without receiving a new order from the treating provider.

There is another specific set of conditions in which the radiologist may change the dimensions of the exam; however, these should only be followed if the ordering physician is unreachable. Unless the exam occurs outside of normal business hours, the ordering physician should be accessible to amend the order.

In this example, it depends on what the order specifies. If the order specifically states two views, then the provider needs to send the order back to the referring physician for an addendum. If the order simply references a chest X-ray, then the provider may make the decision to perform as many views are necessary to appropriately treat the patient.