Part B Insider (Multispecialty) Coding Alert

Published on Thu Oct 04, 2007 PDF

Heads up: Medicare will only pay for diagnostic tests when the -treating physician- or -treating practitioner- orders them, according to newly issued Transmittal 79 (C.R. 5743.)

The treating physician or practitioner is the professional who treats the patient for a specific problem and uses the test results in the management of that problem, the transmittal clarifies. The physician can order the tests by mail, fax, phone or email.

A standing order isn't enough to justify billing for clinical tests under Medicare part B, the transmittal adds.

Watch for: Sometimes the -interpreting physician,- such as a radiologist, cardiologist or neurologist, decides that the treating physician ordered the wrong test.

For example: The treating physician ordered an MRI but the interpreting physician believes a CT scan is more helpful due to clinical indications.

In this case, the interpreting physician can't perform the CT scan, until the treating physician issues a new order. And if the originally ordered test comes back normal but the interpreting physician believes another test is needed, the further tests have to wait for another order from the treating physician.

Exception: If the test the treating physician ordered comes back with an abnormal result and the interpreting physician believes that more tests are necessary and a delay may endanger the patient, then the testing facility can go ahead and do more tests.