Advanced Search

Radiology Coding Alert

READER QUESTIONS :

Keep Additional Test Rules at Your Fingertips

Published on Sat Jun 13, 2009

Question: I have the 2001 CMS transmittal that explains when a radiologist may perform an exam without an order, but does CMS include this in one of the current manuals? Montana Subscriber Answer: Youll find the information youre looking for in the Medicare Benefit Policy Manual, Chapter 15,Section 80.6 (www.cms.hhs.gov/Manuals/IOM/list.asp). There are only a few circumstances where a nonhospital radiologist may perform and charge for an exam without first getting an order from the treating physician. Years ago, Medicare set out a general rule that the radiologist should seek a new order from the treating physician when he thinks he should perform a different diagnostic test because the test is inappropriate or doesnt offer a diagnosis. This is in the transmittal you refer to: www.cms.hhs.gov/transmittals/downloads/R1725B3.pdf. CMS also offered an Additional Diagnostic Radiology Test Exception, allowing the radiologist to furnish the additional test if the testing facility cant reach [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Radiology Coding Alert

View All