Wiki Ancillary Services Prior to Office Visit

[Ozbaby]

I appreciate anyone who weighs in here -

We are a vascular practice that owns ultrasound equipment and staffs sonographers. The providers believe that each patient should have an ultrasound done prior to being seen. For example, a new patient is scheduled for rest pain - they are scheduled for an ultrasound first and then an office visit follows. Established patients follow up for routine ultrasounds and are then seen by a provider for an office appointment. I do not know of another setting where ancillary services are performed prior to being examined, evaluated, etc.

Thoughts please.

 

[AmandaBriggs]

My first concern would be how the provider is supporting the medical necessity of the test without having seen and examined the patient. My second concern would be are they actually completing the orders for this testing to be done beforehand or are they asking the referring providers to order these exams?

 

[davidskm]

It is not uncommon for them to order the noninvasive arterial/venous Doppler/duplex test prior to being seeing. They need to be able to know what's going on in the vessels to see if the lack of flow is what's causing them to come in. At each follow up, a study is ordered just prior to the visit to address how the patients flow is in the vessels-better or worse. If the patient was referred I would think the referring doctor should have already ordered the testing before referring to the specialist, if not it makes good sense for the specialist to order the test or the initial visit might be just a meet and greet without good treatment plans.

 

[thomas7331]

I have seen this with orthopedic physicians as well - they'll have an x-ray done prior to seeing the patient. As long as there is a valid indication for the test being done, I don't think there is anything wrong with this practice.

 

[Ozbaby]

My stance is similar to what you said, Amanda. How is the medical necessity for the studies established without the patient ever being seen by one of the providers? Lay eyes on the patient to evaluate visible symptoms, conduct a PE, collect the history, etc. *before* sending to ultrasound. Regarding established patients returning for follow up, I can see obtaining the u/s first.

I should mention I am new to the practice. In the past, it has been standard to send every single patient to ultrasound first - new, established, seen last month, seen 2 years ago, doesn't matter. Ultrasounds for everyone! The idea of conducting a proper evaluation and management service prior to study is so foreign, I am struggling to make it understood.

 

[davidskm]

I would think if they are ordering a non invasive test for any and all patients that are coming into your office would raise a flag but if you are only following this protocol for the patients coming in for "rest pain" or claudication I would think this is very justifiable. If this was being done for a PCP office I would think it raises flags but the vascular specialist needs eyes on the inside since they are looking at the vessels just as the orthos are looking at the bones. The testing should have enough medical necessity to support the order if not than I would think that one would raise a flag as to why are why ordering this test prior to the visit...the visit would need to happen than the testing.

 

[thomas7331]

Why don't you discuss your questions and concerns with the physicians or practice manager? Medical necessity issues and the reasons for ordering different tests are clinical in nature. In coding, we don't usually have this background and can't really make judgments on this kind of thing without the input of people who actually having that training.