NOTICE TO MEMBERS OF THE

Last year the State Radiological Society posted on its Website the latest Medicare rule concerning reimbursement to radiologists for images ordered by a chiropractor. Medicare had announced that radiologists would no longer be reimbursed for any image ordered by a chiropractor, but that a radiologist could, in appropriate circumstances, order a plain film X-ray (never a CT or MRI) on a patient referred by a chiropractor, provided that such X-ray is for the purpose of “demonstrating a subluxation of the spine”.

This is a somewhat unique situation in which Medicare allows a radiologist to be reimbursed for an X-ray ordered by the radiologist rather than by a treating practitioner.

The State Society desires to clarify its position in respect to certain questions that have arisen in respect to the foregoing Medicare policy:

1. The radiologist considering whether to order such a plain film X-ray should obtain adequate medical information to support the existence of an appropriate basis for the order. Medicare is entitled to audit the radiologist’s records and has the authority to recover the reimbursement paid to the radiologist for the X-ray if it was ordered without an appropriate basis as supported by the medical record. The burden will be on the radiologist, as with every other practitioner being audited, to produce records justifying the order.

2. Some radiologists are unwilling to order any images themselves, including not only for chiropractic-referred patients, but also for screening mammograms. The State Society is unaware of any law that would prohibit the radiologist from adopting such a position, but would emphasize that this is a decision to be made by each radiologist or group of radiologists for themselves and that they may want to consider prior consultation with his/her own legal advisor.

3. Some radiologists are concerned that ordering an X-ray will impose upon them some legal and/or ethical responsibility as a physician of record, that responsibility being some duty to assure that the patient whose image indicates the need for medical followup actually receives such followup care. The Medicare regulation does not address any such issue. The Society’s attorneys have indicated that they cannot assure the Society or its members that there is no such legal or ethical obligation created by such an order. Some radiologists are requiring the referring chiropractor to furnish the radiologists with the name of the patient’s treating health care practitioner before the radiologist will consider ordering an X-ray for that patient. The Society is unaware of any law that would prohibit requiring the identification of the patient’s health care practitioner as a predicate to considering issuing an order. This, too, is a judgment that each radiologist or group of radiologists should make for themselves and should consult with their own legal advisor.

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Department of Radiology
School of Medicine
State University of New York at Stony Brook
Health Sciences Center