Radiologist, diagnositic test, treating physician,treating practitioner defenition

Definitions

A radiologist performing a therapeutic interventional procedure is considered a treating physician. A radiologist performing a diagnostic interventional or diagnostic procedure is not considered a treating physician.

A “diagnostic test” includes all diagnostic X-ray tests, all diagnostic laboratory tests and other diagnostic tests furnished to a beneficiary.

A “treating physician” is a physician who furnishes a consultation or treats a beneficiary for a specific medical problem, and who uses the results of a diagnostic test in the management of the beneficiary’s specific medical problem.

A “treating practitioner” is a nurse practitioner, clinical nurse specialist or physician assistant who furnishes, pursuant to state law, a consultation or treats a beneficiary for a specific medical problem, and who uses the result of a diagnostic test in the management of the beneficiary’s specific medical problem.
A “testing facility” is a Medicare provider or supplier that furnishes diagnostic tests. A testing facility may include a physician or a group of physicians (e.g., radiologist, pathologist), a laboratory or an Independent Diagnostic Testing Facility (IDTF).

An “order” is a communication from the treating physician/practitioner requesting that a diagnostic test be performed for a beneficiary. The order may conditionally request an additional diagnostic test for a particular beneficiary if the result of the initial diagnostic test ordered yields to a certain value determined by the treating physician/practitioner (e.g., if test X is negative, then perform test Y).
An order may include the following forms of communication:

* A written document signed by the treating physician/practitioner that is hand-delivered, mailed or faxed to the testing facility.

Note: No signature is required on orders for clinical diagnostic tests paid on the basis of the clinical laboratory fee schedule, the physician fee schedule or for physician pathology services.

* A telephone call by the treating physician/practitioner or his office to the testing facility.

* An electronic mail by the treating physician/practitioner or his office to the testing facility.

Note: All procedures performed by an IDTF must be specifically ordered in writing by the physician or practitioner who is treating the beneficiary.

If the order is communicated via telephone, both the treating physician/practitioner or his office and the testing facility must document the telephone call in their respective copies of the beneficiary’s medical records. While a physician order is not required to be signed, the physician must clearly document in the Medicare record his intent that the test be performed.

Radiology Billing Basic

Radiology
• Under constant review due to technological advancement
• Four subsections

�� Diagnostic Radiology
70010* - 76499
includes computerized tomography (CT),
magnetic resonance imaging (MRI), and
interventional radiology procedures

�� Diagnostic Ultrasound
76506 - 76999
�� Radiation Oncology
77261 - 77799
�� Nuclear Medicine
78000 - 79999

• Codes ordered according to anatomic site and body system

• Technical and professional components

�� Technical component = TC modifier
Includes the provision of the equipment,
supplies, technical personnel, and costs attendant to theprocedure

�� Professional component = 26 modifier
Encompasses all the physician's work in
providing the service, including interpretation and report of the procedure.
�� Complete procedure = no modifier

Radiology CPT code list

Diagnostic Radiology (Diagnostic Imaging) CPT 70010-76499
Aorta and Arteries CPT 75600-75790
Diagnostic Ultrasound CPT 76506-76999
Radiation Oncology CPT  77261-77799
Clinical Treatment Planning CPT  77261-77299
Radiation Treatment Management CPT  77427-77499
Proton Beam Treatment Delivery CPT  77520-77523
Hyperthermia CPT  77600-77620
Clinical Brachytherapy CPT  77750-77799
Nuclear Medicine CPT  78000-78299
Musculoskeletal System CPT 78300-78399
Cardiovascular System CPT  78414-78499

Radiology ADDED CPT code 74176, 74177, 74178

Radiology – 5 New Codes
– CT Angioplasty Abdomen/Pelvis
• Without Contrast – 74176
• With Contrast – 74177
• Without Contrast 1+ Body Regions – 74178
– Ultrasound Extremity Non-Vascular
• Complete - 76881
• Limited – 76882

• Pathology & Laboratory–15 New & 13 Deleted



Medicine – 40 New & 41 Deleted
– New Codes
• Immunization Administration thru 18 years
– First Vaccine/Toxoid – 90460
– Each Additional – 90461
• H1N1 Immunization Administration, including counseling - 90470
• Meningococcal Vaccine, 2-15 months - 90644
• Influenza Virus Vaccine
– Intranasal – 90664
– Intramuscular, Preservative Free – 90666
– Intramuscular, Split Virus, Adjuvanted – 90667
– Intramuscular, Split Virus – 90668


New Codes
• Therapeutic repetitive transcranial magnetic stimulation treatment;
planning – 90867
– Delivery and management, per session - 90868
• Esophageal Motility (Add-On Code) – 91013
• Sleep Study 95800 - 95801
– Deleted Codes
• Immunization Administration – 90465 – 90468
• Esophageal/Gastric Intubation/Motility – 91000-91105
• Telephonic Transmission of Post-Symptom EKG strips
– 93012 & 93014
• Holter Monitors
– 93230 - 93233
– 93235 - 93237

WRITTEN INTERPRETATION AND REPORT DOCUMENTATION

Based on the increased number of provider questions regarding written interpretation and report of diagnostic X-rays, Medicare expects the separate and distinct report (may be on separate paper or within the body of the patient's record) for the interpretations to follow the American College of Radiology (ACR) guidelines and include a minimum of the following:

* The name of the patient and other identification such as birth date and Social Security number.
* The name of referring physician, if any.
* The name or type of examination performed.
* The date on which the X-ray was performed.
* The name of the interpreting physician.
* Authentication of non-handwritten note (i.e., legible initials, legible signature, electronic signature, etc.).
* The body of the report:
o Procedures and materials.
o Findings.
o Limitations.
o Clinical issues.
o Comparative data, if indicated.

* The diagnosis:
o A prescribing diagnosis should be provided when possible.
o A differential diagnosis should be provided when appropriate.

EKGs AND X-RAYS PERFORMED IN THE EMERGENCY ROOM

Specialty is not the primary factor considered when payment is made for an interpretation of an EKG or X-ray done in the Emergency Room (ER). Payment will be made for the interpretation and report that directly contributed to the diagnosis and treatment of the individual patient. The interpretation billed by the specialist or radiologist is payable if the interpretation of the procedure is performed at the same time as the diagnosis and treatment of the beneficiary or if it is the only bill received. More than one interpretation on the same EKG or X-ray may be allowable under unusual circumstances.

The professional component of a diagnostic procedure furnished to a beneficiary in a hospital includes an interpretation and written report for inclusion in the beneficiary’s medical record maintained by the hospital. The interpretation and report of the procedure is separately payable. A “review” of the findings of these procedures, without a written report, does not meet the conditions for separate payment of the service since the review is already included in the ER visit.

Hospitals are encouraged to work with their medical staffs to ensure that only one claim per interpretation is submitted. The Medicare contractor may determine that the hospital’s “official interpretation” is for quality control and liability purposes only and is a service to the hospital rather than to an individual beneficiary. Separate payment will not be made for interpretations that are done solely for quality control purposes.

Unrelated/Coexisting Conditions/Diagnoses in radiology billing

The physician interpreting the diagnostic test may report unrelated and coexisting conditions/diagnoses as additional diagnoses.

Example: A patient is referred to a radiologist for a chest X-ray because of a cough. The result of the chest X-ray indicates the patient has pneumonia. During the performance of the diagnostic test, it was determined that the patient has hypertension and diabetes mellitus. The interpreting physician reports a primary diagnosis of pneumonia. The interpreting physician may report the hypertension and diabetes mellitus as secondary diagnoses.

Diagnostic Tests Ordered in the Absence of Signs and/or Symptoms (e.g., Screening Tests)

When a diagnostic test is ordered in the absence of signs/symptoms or other evidence of illness or injury, the testing facility or the physician interpreting the diagnostic test should report the screening code as the primary diagnosis code. Any condition discovered during the screening should be reported as a secondary diagnosis.