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Facilities may create standing order for chiropractic x-ray

APCs Weekly Monitor, January 28, 2005

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Facilities may create standing order for chiropractic x-ray

Question: Medicare recently published a Medlearn Matters article which stated chiropractors are not allowed to act as an ordering physician for spine x-rays. Our radiology medical director is willing to be the ordering physician when a chiropractor orders a spine x-ray.

The radiology manager would like to create a standing order for Medicare patients when the chiropractor writes an order for a spine x-ray. The standing order would allow registrars to register the account under the radiology medical director as the ordering physician. Is this practice allowed?

Answer: It is a long-standing rule under Medicare that only a patient's treating physician or appropriately credentialed practitioner can order diagnostic tests.

The chiropractor exception is also fairly longstanding. According to a Medlearn Matters article published July 21, 2004, by CMS, "The only exception to this 'treating physician' rule is the plain x-ray. Medicare does allow a physician other than the one actually treating the beneficiary for the disorder of the spine to order an x-ray to be used for a chiropractor for patient treatment."

What is new is that there is no longer a Medicare prerequisite for a spine x-ray that shows subluxation of the spine prior to coverage of the chiropractor's manipulative treatments. Nevertheless, there are chiropractors who wish to have spine x-rays before they begin therapy and Medicare has provided for this exception.

It is reasonable to develop a standing policy at your hospital whereby a radiologist is automatically designated as the ordering physician for a Medicare patient's spine x-ray, if both the chiropractor and radiologist agree. Chiropractors and the radiology medical director should sign the standing order.

This helps facilitate situations where the patient presents as a walk-in with the chiropractor's order for the spine x-ray. For example, it prevents a patient wait when the patient must wait to ask the chiropractor to give a verbal order to the radiologist.

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