Radiology Coding Alert

Question: May radiologists still order x-rays for Medicare patients referred by chiropractors?

Pennsylvania Subscriber

Answer: No. The 2008 Medicare fee schedule ended the "chiropractic exception" that allowed radiologists to order x-rays for chiropractic patients in the non-hospital setting (hospitals may grant radiologists ordering privileges).

Background: Before Jan. 1, 2000, Medicare wouldn't reimburse chiropractic adjustments to correct subluxations without an x-ray confirming the subluxation diagnosis. Medicare doesn't allow chiropractors to order x-rays, so the "chiropractor exception" allowed radiologists to order x-rays for patients referred by chiropractors (42 CFR Ch. IV, 410.32 (a) (1)).

Reason for change: In 2000, the law eliminated the spinal subluxation x-ray requirement. Fast forward eight years to the 2008 fee schedule, and Medicare finally announced that because it no longer requires x-rays, it will no longer pay "for an x-ray ordered by a nontreating physician when a chiropractor, not the ordering physician, will use that x-ray" (http://www.cms.hhs.gov/physicianfeesched/downloads/cms-1385-FC.pdf).

-- The answers for You Be the Coder and Reader Questions were reviewed by Jackie Miller, RHIA, CPC, senior consultant with Coding Strategies Inc. in Powder Springs, Ga.