Golden rules for radiology technicians

In the world of radiology technicians, these tips are gospel, according to three experts in the field who sat down with RACRI recently.

Consultant: Cohesion is the key

“In a perfect world, technologists would understand coding and reimbursement, as well as the compliance implications of things that are done [or not done] on a daily basis,” says Stacie L. Buck, RHIA, CCS-P, LHRM, RCC, vice president of Southeast Radiology Management in Stuart, FL. “What I would love to see is technologists and coders working closely together, as each has valuable knowledge to share with the other.”

Buck’s golden rule for radiologist technicians is: Do not stray from the path of the ordering physician. If a technician strongly feels that a change should be made to the orders, he or she needs to talk to the physician before proceeding.

“The technologist should not perform a test different from that which was ordered,” says Buck. “The ordering physician should be consulted regarding any changes to a test order, and a corrected order should be requested from the ordering physician.”

There are some exceptions to this rule. But even so, the radiologist should be the one to make those -modifications, for billing reasons.

In the world of healthcare billing, Medicare runs the show. And it says, for example, that the ordering physician determines whether a screening is more appropriate than a diagnostic mammogram.

In this regard, a communication slipup with mammography is a severe problem, especially if the ordering physician requests a screening, but the technologist performs a diagnostic mammogram, Buck says.

Even if the patient says she has a history of breast cancer, “Medicare rules state [that] the ordering physician makes the determination as to whether or not a screening is more appropriate” than a diagnostic exam.

Poor communication also leads to poor public relations with patients.

If a patient gets a bill for a diagnostic exam because his or her insurance does not cover it, he or she could become irate.

Technologists should familiarize themselves with the guidelines in the CPT manual because they may often have the responsibility of selecting the CPT codes to be assigned, Buck says. Ultrasound coding is a perfect example, as there are specific requirements for proper coding of diagnostic ultrasounds.

“Another problem with orders being modified [different exam performed or different parameters] is that many diagnostic exams must be preauthorized by the payer, and many require an exact CPT code match to pay the claim,” Buck says. “If there is not a code match on the claim and the authorization, the service is denied for no authorization.”

Compliance officer: Ask questions, know the rules

Larry W. Balmer, CCP, compliance officer, HIPAA privacy and security, at Radiology Incorporated in Mishawaka, IN, says technologists should:

Radiologist technologists should also speak up when they recognize a test is not medically necessary.

“Question it,” says Balmer.

Many times, the technologist is able to find out things about the patient’s condition that may have been missed during registration. He or she “can use some sound judgment as to whether the test is truly necessary for the reason provided, or if the test may even be a wrong one,” he says.

Compliance administrator: Document, document, document

An undocumented trip to the x-ray room can only cause headaches when reimbursement time comes, says Janet Duffy, RT, compliance administrator for Radiological Associates of Sacramento, CA, a physician-owned group.

“You must document exactly what you did—number of views, contrast given or not given,” Duffy says. “Your chart documentation could be what decides whether an exam is paid for or not.”

Technologists should do only what the physician ordered—no more, no less—unless an actual health emergency exists or there is a clear error. In an outpatient setting, these are rare occurrences. Something done “for the patient’s convenience” does not constitute an emergency, she says.

In the outpatient setting, the radiologist cannot order exams, except changing a screening mammogram to a diagnostic mammogram when an abnormality is found.

If you take a verbal order—or change order—it must be documented correctly.

“You cannot look up records of friends, relatives, acquaintances, [or] coworkers unless you have a job-related reason to do so,” Duffy says. “We do not offer professional courtesy, and you cannot have or perform an exam on a friend without a doctor’s order.”

If the CPT and ICD-9 code descriptions on your paperwork don’t match the referral or the patient’s understanding, you need to get them changed so that the entire billing chain is consistent and correct.

If you fudge the history or reason for an exam so that insurance will pay for it, even if the referring physician or patient asks you to, you are committing insurance fraud.

Losing track of a patient’s care can also hurt a facility. “If it isn’t documented, it didn’t happen,” Duffy says. “This refers to asking about pregnancy before x-raying a woman, asking about allergies, giving medication, giving any postprocedure instructions, etc. It has to be correctly documented in the medical record to be useful in a defense.”

Insider sources

Larry W. Balmer, CCP, compliance officer, HIPAA privacy and security, Radiology Incorporated, Mishawaka, IN, 574/258-1100, Ext. 284; lbalmer@rad-inc.com.

Janet Duffy, RT, compliance administrator, Radiological Associates of Sacramento Medical Group, Inc., 1500 Expo Parkway, Sacramento, CA, 95815, 916/646-8300; RADuffy@radiological.com.

Stacie L. Buck, RHIA, LHRM, vice president, Southeast Radiology Management, 512 SW St. Lucie Crescent, Stuart, FL 34994, 772/600-0324; stacie@southeastrad.com.

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