Radiology Coding Alert

Question: I know that radiologists typically can't order tests, but are there any exceptions to this rule?


Delaware Subscriber

Answer: Medicare allows a number of exceptions related to screening mammograms, test design, error, patient condition, and studies ordered by interventional radiologists who have assumed the care of a patient.

Screening mammogram: If the radiologist detects something abnormal during a screening mammogram, he may perform a diagnostic mammogram without checking with the treating physician.

Test design: CMS rules allow the radiologist to decide the parameters of a diagnostic test, such as the number of radiographic views, thickness of tomographic sections, and use of contrast. Careful: If the treating physician specifies test design in the order, the radiologist must follow those instructions.

Error: If an order has an error a layman could detect, the radiologist may modify the service without notifying the treating physician. Example: The treating physician orders an x-ray of the left hand even though the right thumb is broken.

Patient condition: If a patient is physically unable to undergo an ordered diagnostic test, the radiologist may cancel the test without alerting the ordering physician. Note: If you perform any medically necessary preliminary testing before the radiologist cancels the diagnostic, you may code for those preliminary tests.

Also, if the radiologist believes that the patient's health will be jeopardized and despite best attempts the referring physician cannot be reached, the radiologist is authorized to provide the correct test and to later notify the referring physician.

Interventional radiologist assuming care of patient: If the interventional radiologist assumes the care of the patient after referral or after performing an interventional procedure, the radiologist may order tests pertinent to the subsequent care of the patient.

You can find Medicare's rules on exceptions to diagnostic testing orders at the CMS Web site www.cms.hhs.gov/manuals/pm_trans/R1787B3.pdf.