Tuesday, June 22, 2010

Radiology billing rule - covered diagnosis, Procedure and POS

DIAGNOSIS REQUIREMENTS

If you bill for patients receiving only diagnostic or therapeutic services during a visit, the primary
diagnosis should be the condition, problem, or other reason for the service. Bill codes for other
diagnoses (e.g. chronic conditions) as additional diagnoses.


PLACE OF SERVICE

Coverage of service is considered in the following place of service: office (11), home (12),
inpatient (21), outpatient (22), nursing home (32), or kidney treatment center (65).

COVERED RADIOLOGY SERVICES

1) X-ray services furnished by a physician or an approved radiology group that relate to
a medically necessary diagnosis, symptom, or injury.
2) Purchased Diagnostic Test (PDT). (See PDT instructions in the Coding section.)
3) Medically Necessary anesthesia for a CT scan.
4) Portable X-rays. (See Portable X-ray instructions in the Specialty section.)
5) Magnetic Resonance Angiography (MRA) is considered when:
a) It is reasonable and necessary for the diagnosis or treatment of a patient;
b) Services are performed in a hospital, office or in an approved mobile unit in
which a physician is always in attendance. (See the appropriate policy in the
“Policies” section of Vol. 2 for more information.)
6) Magnetic Resonance Imaging (MRI) is considered when:
a) It is reasonable and necessary for the diagnosis or treatment of a patient.

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