decisionhealth Newsletters, decisionhealth - 2011 Issue 4 (April)
Gastroenterology RoundUp: When PCP orders screening but a diagnostic test is warranted
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Article Overview
This gastroenterology coding article addresses Medicare policy for situations where a primary care physician’s test order does not match the patient’s clinical presentation. It discusses the role of the ordering physician, how an amended order may be obtained, and the documentation expected in the medical record. The piece is relevant to GI practices, facilities, and coding/billing staff who need to understand how ordered tests, patient symptoms, and Medicare documentation requirements intersect.
Why This Topic Matters
Knowing when an order must be revised and documented helps practices avoid billing and medical record problems when the requested service and the clinically appropriate service differ. It is especially important for gastroenterology teams that work with screening and diagnostic colonoscopy referrals under Medicare.
What You Will Learn
- How Medicare treats situations where the ordered test differs from the clinically appropriate test
- What type of communication may be used to obtain an amended order
- What documentation should be retained when the order is changed
- Why the performing physician or facility should follow the ordering physician’s request until a new order is received
Who Should Read This
- Gastroenterologists
- Primary care physicians
- Medical coders
- Medical billers
- Revenue cycle staff
- GI practice managers
- Outpatient facility staff
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