AMA Clinical Examples in Radiology - 2023 Issue 1 (Winter)
Questions and Answers
Winter 2023 pages 17-18 QUESTIONS AND ANSWERS Question Answer If the radiologist wants to change the examination from a diagnostic mammogram to an ultrasound, can the order be changed without obtaining a new order from the referring physician? According to the Medicare Carrier's Manual Transmittal 1725, "When the radiologist at a testing facility determines that an ordered diagnostic radiology test is clinically inappropriate or suboptimal, and that a different diagnostic test should be performed (e.g., an MRI should be performed instead of a CT scan because of the clinical indication), the radiologist/testing facility may not perform the unordered test...
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Article Overview
This article compiles practical radiology questions and answers focused on Medicare coverage policy, imaging order requirements, and coding/reporting considerations. It addresses screening versus diagnostic imaging, use of unlisted and guidance codes, and diagnosis code selection for lung cancer screening and surveillance contexts. The content is aimed at radiology coders, billing staff, and ordering providers who need to understand how Medicare and related guidance affect documentation and claim reporting.
Why This Topic Matters
The article helps readers understand when imaging studies may be covered, how to distinguish screening from diagnostic services, and which broad coding resources and diagnosis categories are discussed in the context of Medicare policy.
Article Sections
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Winter 2023 pages 17-18
A short question-and-answer collection addressing Medicare-related radiology coverage and reporting topics. The section spans mammography, breast ultrasound, lung imaging, and marker placement.
What You Will Learn
- How Medicare policy affects changes to ordered diagnostic imaging studies
- What the article says about screening versus diagnostic breast ultrasound coverage
- How the article frames reporting for image-guided marker placement
- Which broad diagnosis categories are discussed for lung cancer screening and surveillance imaging
- What Medicare-related guidance sources are referenced in the discussion
Who Should Read This
- Radiology coders
- Radiology billing staff
- Ordering providers
- Diagnostic imaging facility staff
- Compliance and reimbursement professionals
Codes Discussed
Code Ranges Discussed
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