Wiki Performing a diagnostic test on a patient who has not established care

[kburow5446@gmail.com]

My manager has the following question and I am hoping someone might be able to answer this:

We are a Urology clinic who has been asked to performed the ARM (diagnostic testing which is called anorectal manometry for fecal incontinence) by another clinic. So they want to send their patients here only for us to perform this test. These patients are not our patients so have no established care with us. My managers concern is that we are not considered a diagnostic testing facility, so how can we can we truly perform these tests on patients who have no established care with us and can we actually bill for these?
We do the technical and professional component of these and those results are provided to their primary doctor who sent them here to be tested.

I appreciate your feedback. Myself and our other Coder do not see any issues with this and believe we should be able to bill, but would like to check into it a little more before getting back to management.

Thank you
Kelly COC

 

[thomas7331]

If your practice has the required credentials and certifications necessary to perform this test on your own patients, then you should be able to do the test for patients of outside providers too. There is no requirement that I have ever heard of that a patient has to be established to the provider or practice that does the test. You do have to have a valid order from the provider who is requesting the test, but your own provider does not have to be the one ordering it. To be completely sure and avoid any doubts, you might want to have your practice lawyers verify this - the forum discussions are not a 100% reliable source of information as regulations can vary with the location and/or particulars of your individual situation.