RADIOLOGY question

[shannon789]

I have been trying to research this & have found nothing so far. I work at a multi-specialty clinic & we currently have a situation where Radiology is sending patients to our Surgical Oncologist for a “surgical consult.” Do you think it’s okay for a Radiologist to be the requesting physician on a consultation (E&M codes 99241—99245)?

Our first response was no, because Radiologists, like Pathologists, do not treat patients so the logic is that they cannot ask for recommendations on treatment. But then if you think about it some more, if a Radiologist does an x-ray & sees an abnormality & feels that further evaluation may be necessary, he is not able to order any further studies. So he has to ask another physician to see the patient & recommend whether or not further studies are warranted. A consult can be requested for recommendations on treatment &/or evaluation, so you could argue that the Radiologist is requesting the other physician’s opinion on whether or not the pt. requires further evaluation.

A typical scenario is that the patient’s PCP finds a lump in her breast, so the PCP orders a diagnostic mammogram. Radiology performs the mammogram, confirms the presence of an abnormality, and sends the patient to Surgical Oncology. When Surgical Oncology sees the patient, they are billing a consultation w/the requesting physician listed as Radiology. Surgical Oncology reviews the films already taken & usually orders an MRI, so the patient is then sent back to Radiology.

I would appreciate anyone's help &/or advice. Thanks!
~Shannon

[tracy022373]

I code for a Radiology Department for over 2 years now. Like you we are multi-specialty. The radiologist can put his recommendations on the report for further treatment or for a follow up exam, but not actually refer a patient to a specialist.
The radiologist reads the report for the ordering doctors, so that ordering doctor should get the report and handle the results with the patient. If the patient need to go to a specialist that should come from the doctor who ordered the x-ray and not the radiologist who read it.
So in the example you gave a PCP finds a lump and sends her for a diagnostic mammogram. The radiologist confirms the presence of the abnormality and recommends a surgical consult. That report should go back to the PCP and he should discuss this with the patient and the PCP should refer the patient to a surgeon.
Good luck!!! Hope this helped!!

[shannon789]

Thanks, Tracy! I agree with you that the Radiologist's report should go back to the PCP. That definitely makes sense. Not sure how we're going to work it out yet though.
Thanks again!