Wiki Mammogram scenario

[kristen.mangas@yahoo.com]

Hello,

A patient presents with a screening mammogram script. We see a nodule in one breast and the radiologist wants a breast US. Do we need a new script from the referring ordering the breast US? We have been told we do not, it falls under some "umbrella clause" that the radiologist can order this?

Thanks everyone.

Kristen

 

[jkayser]

Hi, please see the Question/Answer info and link from Radiology Today:

http://www.radiologytoday.net/archive/rt1112p20.shtml

Are Your Orders in Good Order? ? Tips for Getting Your Ducks in a Row to Ensure Proper Orders and Reimbursement By Melody W. Mulaik, MSHS, RCC, CPC, CPC-H, PCS Radiology Today Vol. 13 No. 11 P. 20 - See more at: http://www.radiologytoday.net/archive/rt1112p20.shtml#sthash.WEhxoP3c.dpuf

"Q: When can an imaging facility perform a different exam without obtaining an updated order from the treating physician?"

"A: For Medicare, if an order does not specify the exam protocol?for example, the number of views or whether contrast should be used?the radiologist may make this determination based on the patient?s clinical indications without notifying the referring physician. This is usually referred to as a ?test design? decision. The radiologist also may change an order when it contains an error that would be obvious even to a layperson. For example, if the treating physician orders an X-ray of the left ankle to check the alignment of a patient?s fracture, but it is the right ankle that is fractured, the facility can perform a right ankle X-ray without contacting the referring physician. If the patient?s condition will not permit the exam to be performed as ordered, the radiologist may cancel the exam without notifying the referring physician. Any medically necessary ?scout? testing is payable. There also is an exception to the ordering rules for situations when the radiologist determines that an additional exam is needed due to an abnormal result of the exam that the treating physician ordered but the treating physician is unavailable to provide an order. There are detailed requirements for providing and documenting the additional service (see Medicare Benefit Policy Manual, Chapter 15, Section 80.6.3). Finally, the facility does not need a new or revised order to perform an exam that the treating physician conditionally ordered. For example, the physician orders a breast ultrasound after a diagnostic mammogram, if clinically indicated. You do not need an updated order if it is determined that the ultrasound exam is necessary. If your system does not have the built-in capability for physicians to place conditional orders, updating your internal exam code to the conditionally requested study would not be considered an order change. If your computerized physician order entry system requires that you update the order to the conditionally requested study, you should verify that the original order with the conditionally requested study remains in the system. - See more at: http://www.radiologytoday.net/archive/rt1112p20.shtml#sthash.WEhxoP3c.dpuf

I hope this will be helpful.

Jean Kayser CPC CIRCC

 

[kristen.mangas@yahoo.com]

mammogram scenario

Thanks so much !!