Radiology Coding Alert

Question: If a referring physician orders a bone scan and the interpreting radiologist requires x-rays for correlation, can the x-rays be obtained, coded and billed without a specific prescription or referral from the original physician? We encountered this situation recently and the charges were denied.

FL Subscriber

Answer: According to Cheryl Schad, BA, CPCM, CPC, owner of Schad Medical Management in NJ, the consensus among coding professionals is that it would be highly unusual for this to be allowed. The interpreting radiologist does not have the latitude to add tests or scans to the referring physicians orders.

However, if the radiologist feels additional films are needed, he or she may contact the referring physician for verbal approval. If this is done, she says, the radiologist needs to make notes on the patients chart explaining what was originally ordered and why additional films are indicated. The chart should also contain a thorough record of the consultation with the referring physician, and confirm his or her verbal order.

The only exception to this rule of thumb, Schad says, may
occur during screening mammography. In this instance, if the radiologist sees something unusual, he or she may conduct appropriate diagnostic testing without consulting with the requesting physician.