Forum - Questions & Answers
Orders vs Protocol
Have a question regarding Hospital protoco VS Orderl:
If an ER Physician orders a 2 view unilateral rib xray and the hospital protocol is to perform a 2 view unilateral rib and included a PA chest, can the Radiologist add the PA chest view automatically and bill for this service accordingly or does the ER physician have to specifically state a unilateral rib including PA chest?
Having trouble finding documentation that addresses this issue specifically. Thank you for any assistance
order
Hospital protocol does not set billing rules. Any x-ray must have a physician order. Reimbursement is based on orders and medical necessity.
order
https://www.cms.gov/transmittals/downloads/R80BP.pdf
Further Clarification
Thank you for the response. I would like to further clarify the situation to ensure we are billing correctly.
An ER Physician orders a 2view unilateral rib on patient, (CPT 71100) Hospital protocol states that all 2view unilateral rib xrays include a posteroanterior chest. Our Radiologist performs a "Radiologic examination, ribs, unilateral including posteroanterior chest, minimum of 3 views" (CPT 71101) even though the ER Physician did not specifically order the PA chest.
Does hospital protocol override a physician order in this example?
Thank you so much for your assistance
No
No, it does not. Bill what was ordered only!