Requirements for an orbits x-ray for foreign body screening prior to an MRI

Q.

In a hospital setting, is an order required for an orbits x-ray for foreign body screening prior to an MRI? They don’t do orbits on everyone, only those who have an indication, like history of welding.

A.

For Medicare, in the hospital the radiologist may order additional or different tests as medically necessary; you don’t have to get an order from the referring physician. The radiologist does need to document (usually in the report) his or her decision to order that test and why it was medically necessary for the individual patient. 

Other payors may, of course, have differing policies.