Wednesday, May 18, 2011

Interpreting Physician Exception

This exception applies to an interpreting physician of a testing facility who furnishes a diagnostic test to a beneficiary who is not a hospital inpatient or outpatient. The interpreting physician must document accordingly in his report to the treating physician/practitioner.

* Test Design: Unless specified in the order, the interpreting physician may determine, without notifying the treating physician/practitioner, the parameters of the diagnostic test (e.g., number of radiographic views obtained, thickness of tomographic sections acquired, use or non-use of contrast media).

* Clear Error: The interpreting physician may modify, without notifying the treating physician/practitioner, an order with clear and obvious errors that would be apparent to a reasonable layperson, such as the patient receiving the test (e.g., X-ray of wrong foot ordered).

* Patient Condition: The interpreting physician may cancel, without notifying the treating physician/practitioner, an order because the beneficiary’s physical condition at the time of diagnostic testing will not permit performance of the test (e.g., a barium enema cannot be performed because of residual stool in colon on scout KUB; PA/LAT of the chest cannot be performed because the patient is unable to stand). When an ordered diagnostic test is canceled, any medically necessary preliminary or scout testing performed is payable.

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