General Surgery Coding Alert - 2007 Issue 36
The Treating Physicians Is In The Driver's Seat For Diagnostic Tests
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Article Overview
This article explains Medicare Part B guidance on who must order diagnostic tests, the distinction between treating and interpreting physicians, and how newly issued guidance affects billing and test workflow. It is relevant for providers, radiology and diagnostic testing facilities, and billing/coding staff who need to understand the general policy framework around diagnostic test orders and follow-up testing.
Why This Topic Matters
The topic matters because diagnostic test claims and medical necessity documentation can depend on whether the order came from the appropriate clinician and whether additional testing was initiated under the permitted circumstances described in the guidance.
What You Will Learn
- The general Medicare policy framework for ordering diagnostic tests
- The difference between treating and interpreting physicians in test ordering
- How standing orders are treated under the guidance
- How follow-up testing is discussed when results are abnormal or unexpected
- Which organizations and transmittal guidance are referenced
Who Should Read This
- Physicians
- Treating practitioners
- Radiologists
- Cardiologists
- Neurologists
- Diagnostic testing facilities
- Medical coders
- Billing staff
- Compliance staff
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