Radiology Coding Alert

Question: Sometimes the radiologist requires additional views to gain more diagnostic information. For a Medicare patient, should we enter a new order (which would generate an additional charge) for these images? Ohio Subscriber Answer: For non-hospital Medicare patients, in most situations you will need an additional order from the treating physician for the added views. In Transmittal 1725, CMS states that when a testing facility radiologist thinks an ordered test is inappropriate or believes a patient with normal results needs another test, the treating physician must send an order for the new test before your center performs it (www.cms.hhs.gov/transmittals/downloads/R1725B3.pdf). And the Correct Coding Initiative (CCI) manual states, "If the radiologist elects to obtain additional views after reviewing initial films in order to render an interpretation, the Medicare policy on the ordering of diagnostic tests must be followed" (Chapter 9, Section C, www.cms.hhs.gov/NationalCorrectCodInitEd/). Exception: If your center can't reach [...]