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Radiology Coding Alert

YOU BE THE CODER--Are Conditional Orders Allowed?

Published on Mon Feb 26, 2007

Question: I work in a freestanding center, and I have an order that says to perform a diagnostic mammogram and to perform an ultrasound if the radiologist identifies a mass. Can I code for the ultrasound if performed? I thought ordering physicians couldn't give conditional orders.


Washington Subscriber


Answer: Conditional orders are valid when:

1. they are for a specific patient rather than being a standing order, such as "perform an ultrasound on any patient whose mammogram is abnormal"

2. the treating physician specifies in the order which result of the first test will trigger the second test. The order to perform a breast ultrasound (76645, Ultrasound, breast[s] [unilateral or bilateral], real time with image documentation) when the radiologist identifies a mass during a diagnostic mammogram (77055, Mammography; unilateral; or 77056, ... bilateral) should pass muster.

Resource: CMS spells out this instruction in 2001 Transmittal 1725 (www.cms.hhs.gov/transmittals/downloads/R1725B3.pdf).
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