Page 117 - Medicare Benefit Policy Manual

If the order is communicated via telephone, both the treating physician/practitioner or
his/her 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 medical record, his or her intent that
the test be performed.

80.6.2 - Interpreting Physician Determines a Different Diagnostic Test is
Appropriate
(Rev. 80; Issued: 01-11-08; Effective: 01-01-03; Implementation: 11-19-07)

When an interpreting physician, e.g., radiologist, cardiologist, family practitioner, general
internist, neurologist, obstetrician, gynecologist, ophthalmologist, thoracic surgeon,
vascular surgeon, at a testing facility determines that an ordered diagnostic radiology test
is clinically inappropriate or suboptimal, and that a different diagnostic test should be
performed (e.g., an MRI should be performed instead of a CT scan because of the clinical
indication), the interpreting physician/testing facility may not perform the unordered test
until a new order from the treating physician/practitioner has been received. Similarly, if
the result of an ordered diagnostic test is normal and the interpreting physician believes
that another diagnostic test should be performed (e.g., a renal sonogram was normal and
based on the clinical indication, the interpreting physician believes an MRI will reveal the
diagnosis), an order from the treating physician must be received prior to performing the
unordered diagnostic test.

80.6.3 - Rules for Testing Facility to Furnish Additional Tests
(Rev. 80; Issued: 01-11-08; Effective: 01-01-03; Implementation: 11-19-07)

If the testing facility cannot reach the treating physician/practitioner to change the order
or obtain a new order and documents this in the medical record, then the testing facility
may furnish the additional diagnostic test if all of the following criteria apply:

• The testing center performs the diagnostic test ordered by the treating
physician/practitioner;

• The interpreting physician at the testing facility determines and documents that,
because of the abnormal result of the diagnostic test performed, an additional
diagnostic test is medically necessary;

• Delaying the performance of the additional diagnostic test would have an adverse
effect on the care of the beneficiary;

• The result of the test is communicated to and is used by the treating
physician/practitioner in the treatment of the beneficiary; and

• The interpreting physician at the testing facility documents in his/her report why
additional testing was done.