Radiology Coding Information for Referring Physicians

Soon your office should be receiving a letter from Dr. Mayewski’s office. The letter addresses RIPA’s and Medicare’s new guidelines for the appropriate use of radiology procedures. In addition, it outlines the new criteria required by RIPA when ordering radiology procedures. Financial penalties for both the ordering physician and the radiologist can be imposed if these criteria are not met.

Ordering physicians and radiologists need to assure that documentation supporting the need for radiology exams is complete and adequately details patient signs and symptoms. Strong Health radiologists must rely on the information provided on requisitions or by phone during the scheduling process to clinically assess the patient’s needs. Often that information is incomplete or inadequate requiring radiology to call the referring physician to obtain more information.

In an effort to improve patient care and minimize the repeated call backs to the referring physicians, the Medical Center, like Borg, RGH and UMI, is requiring the ordering physicians to provide us with the following information for all RIPA and Medicare patients:

• ICD-9 Code(s) and narrative description explaining the reason for the radiology exam must be provided on the radiology requisition or when scheduling by phone. Remember that "rule-out" language is unacceptable;
• The records of the ordering physician must reflect the same signs and symptoms supplied on the requisition;
• Before performing an exam for which the patient’s signs and symptoms do not meet RIPA or Medicare guidelines, the ordering physician will provide the radiologist with further exam rationale to allow the radiologist to schedule the examination, with the understanding that the patient may be responsible for the cost of the examination.

Understanding that this may cause some concern for many referring offices, radiology has initiated several informational sessions scheduled for next week. The times of these sessions are listed below. Please call 273-4066 or email me at Robert_White@urmc.rochester.edu to reserve a seat. If you are unable to attend, contact our web site www.urmc.rochester.edu/smd/Rad/schexam.htm for the most up to date information.