Radiology Billing Checklist: Rules for Additional Tests without Treating Physician’s Order

Keep these additional test rules at your fingertips if your want to keep auditors out of your hair.

The Office of Inspector General and Recovery Audit Contractors are out to audit non-compliant ultrasound claims, so knowing the rules is more important than ever. And we’ve got a link and a handy checklist to keep you out of trouble.

If you’re wondering when a radiologist can bill for a test without the treating physician’s order, we’ve got the link where CMS answers your question, plus a handy checklist.

CMS explains when a radiologist can bill for a test without the treating physician’s order in the Medicare Benefit Policy Manual, Chapter 15, Section 80.6.

There are only a few circumstances where a non-hospital radiologist may perform and charge for an exam without first getting an order from the treating physician.

Years ago, a Medicare transmittal 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 doesn’t offer a diagnosis.”

CMS also offered an “Additional Diagnostic Radiology Test Exception,” allowing the radiologist to furnish the additional test if the testing facility can’t reach the treating practitioner to change the order, if you meet the following:

• You perform the ordered test

• The interpreting physician determines and documents that abnormal test results make the additional test medically necessary

• Delay would harm the patient

• You send the treating physician the test result and he uses it in the treatment

• The radiologist documents the reason for the additional tests.

• The radiologist also may determine test design if it isn’t specified, modify an order that has clear errors, and cancel a test if the patient’s condition requires it.

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AUDIO TRAINING EVENT: OIG & CMS rev up scrutiny for ultrasound imaging. Are you on their hit list?

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