All healthcare insurers, including Medicare and the Rochester Individual Practice Association, Inc. (RIPA), have established guidelines dictating the appropriate use of radiology services. Penalties for both the ordering physician and the radiologist may be imposed if the guidelines are not followed.
To comply with Medicare and RIPA policies, the following criteria must be met when ordering imaging exams:
- ICD code(s) provided on the requisition.
- Narrative description of pertinent patient history, signs, and symptoms. "Rule out" or similar phrases are not acceptable.
- The records of the referring physician must reflect the same signs and symptoms supplied on the exam requisition.
The above information is essential for appropriate and efficient patient care. Your cooperation in this matter is greatly appreciated.