Definitions
A radiologist performing a therapeutic interventional procedure is considered a treating physician. A radiologist performing a diagnostic interventional or diagnostic procedure is not considered a treating physician.
A “diagnostic test” includes all diagnostic X-ray tests, all diagnostic laboratory tests and other diagnostic tests furnished to a beneficiary.
A “treating physician” is a physician who furnishes a consultation or treats a beneficiary for a specific medical problem, and who uses the results of a diagnostic test in the management of the beneficiary’s specific medical problem.
A “treating practitioner” is a nurse practitioner, clinical nurse specialist or physician assistant who furnishes, pursuant to state law, a consultation or treats a beneficiary for a specific medical problem, and who uses the result of a diagnostic test in the management of the beneficiary’s specific medical problem.
A “testing facility” is a Medicare provider or supplier that furnishes diagnostic tests. A testing facility may include a physician or a group of physicians (e.g., radiologist, pathologist), a laboratory or an Independent Diagnostic Testing Facility (IDTF).
An “order” is a communication from the treating physician/practitioner requesting that a diagnostic test be performed for a beneficiary. The order may conditionally request an additional diagnostic test for a particular beneficiary if the result of the initial diagnostic test ordered yields to a certain value determined by the treating physician/practitioner (e.g., if test X is negative, then perform test Y).
An order may include the following forms of communication:
* A written document signed by the treating physician/practitioner that is hand-delivered, mailed or faxed to the testing facility.
Note: No signature is required on orders for clinical diagnostic tests paid on the basis of the clinical laboratory fee schedule, the physician fee schedule or for physician pathology services.
* A telephone call by the treating physician/practitioner or his office to the testing facility.
* An electronic mail by the treating physician/practitioner or his office to the testing facility.
Note: All procedures performed by an IDTF must be specifically ordered in writing by the physician or practitioner who is treating the beneficiary.
If the order is communicated via telephone, both the treating physician/practitioner or his 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 Medicare record his intent that the test be performed.
