Diagnostic tests without orders pose billing issues

Why This Topic Matters

Radiology claims can be vulnerable when a test, protocol element, or diagnosis selection is not clearly supported by an order or documentation. Understanding the topics covered here helps practices evaluate billing risk, documentation practices, and audit exposure without relying on unsupported assumptions.

Article Sections

1. Diagnostic test without an order

   Discusses the article’s first compliance issue involving diagnostic testing and the need for physician or practitioner direction. It also notes differing interpretations of Medicare-related guidance by CMS and the ACR.

2. Billing for diagnostic services performed under protocols

   Covers concerns about protocol-driven diagnostic services in radiology and the broader compliance implications for services performed beyond the original request. The section references CMS, the ACR, and a radiology coding and billing expert.

3. Coding without benefit of documentation

   Addresses documentation gaps that affect diagnosis-code selection and the handling of radiology reports when key details are missing. It also discusses the role of documentation in supporting medically necessary services and audit review.