Week of December 9, 2013
When the physician's order states pelvic ultrasound and during the exam it is determined that a transvaginal ultrasound is also required, does the radiology department need to obtain an additional order from the ordering physician or can the transvaginal US be performed and medical necessity documented in the radiologist dictation?
For Medicare patients, if this is a hospital service (inpatient or outpatient), the radiologist can order the transvaginal exam based on medical necessity. He should clearly document this within his report, and the two exams should be documented in (at least) separate paragraphs.
For payers other than Medicare, you would need to check the individual policy, especially if the initial scan was preauthorized.
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