Radiology Coding Alert

Question: Would you direct me to authoritative guidance on who can order inpatient and outpatient diagnostic tests?


Massachusetts Subscriber

Answer: You'll find the rules for the ordering of diagnostic tests in a non-hospital setting in the Code of Federal Regulations (CFR) at 42 CFR section 410.32. You can view the regulations on the Web site of the Government Printing Office at www.access.gpo.gov/nara/cfr/cfr-table-search.html#page1.

You can also find these rules in Section 15021 of the old Medicare Carriers Manual, Part 3.

You'll find the rules for ordering diagnostic tests in a hospital setting at 42 CFR section 482.26.

Caution: You might think it's OK for a radiologist with clinical privileges to order a test in the hospital because section 482.26 says you can only provide radiology services on the orders of practitioners with clinical privileges (or other practitioners authorized by the medical staff and governing body, as long as you're consistent with state law)--but be careful.

Reality: Fiscal intermediaries often deny claims unless you have an order from the treating physician. If the interventional radiologist orders follow-up imaging studies, you may be able to successfully appeal the denial if the medical record supports the treating status of the interventional radiologist.