Page 118 - Medicare Benefit Policy Manual

EXAMPLE:

The last cut of an abdominal CT scan with contrast shows a mass requiring a pelvic CT
scan to further delineate the mass; (b) a bone scan reveals a lesion on the femur requiring
plain films to make a diagnosis.

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

The following 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/her 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; 170.5PA/LAT of the chest
cannot be performed because the patient is unable to stand). When an ordered diagnostic
test is cancelled, any medically necessary preliminary or scout testing performed is
payable.

80.6.5 - Surgical/Cytopathology Exception
(Rev. 80; Issued: 01-11-08; Effective: 01-01-03; Implementation: 11-19-07)

This exception applies to an independent laboratory’s pathologist or a hospital
pathologist who furnishes a pathology service to a beneficiary who is not a hospital
inpatient or outpatient, and where the treating physician/practitioner does not specifically