Dear Readers,
What is the difference between a “medical test” and a “diagnostic procedure”? According to Wikipedia,[1] “a medical test is a kind of medical procedure performed to detect, diagnose, or evaluate disease, disease processes, susceptibility, and determine a course of treatment.” However, physicians do not use the terms “test” and “procedure” interchangeably. The word “procedure” usually implies something invasive. But what is the definition of invasive?

A medical test is typically a noninvasive diagnostic test that is not associated with “significant risk” to the patient. An example is an electrocardiogram. When ordering a medical test, the physician must consider the appropriateness and cost of the test but not the risks of the test; a physician orders a test. A diagnostic procedure, on the other hand, usually implies an invasive procedure that carries some risk. When considering a diagnostic procedure for a patient, the physician must weigh the risks and benefits of the procedure with the patient. A physician usually does not order an invasive procedure, but typically refers the patient to another physician who will be performing the procedure. The physician who will be performing the procedure evaluates the patient before the procedure, takes responsibility for obtaining consent and completes the procedure. An example of a procedure is a diagnostic EP study for risk stratification of sudden death. Occasionally, the physician who performs the diagnostic procedure does not meet the patient until immediately before the procedure. The culture in the coronary catheterization laboratory usually is one where the referring physician schedules the procedure, and the cardiologist meets the patient on the day of the procedure. In electrophysiology, most patients are evaluated before the day of the procedure by the physician who will be performing the procedure.

Three recent encounters with different Radiology Departments highlight the problem that occurs when a non-invasive procedure that is associated with significant risks is considered a test rather than a procedure.

The first encounter was with a Radiology Department scheduler, who was calling to inform the ordering physician that the task of obtaining preauthorization from the insurance company was the responsibility of the ordering physician. Insurance companies restrict access for medical imaging in some cases by requiring a physician phone call when preauthorization is denied. This can be time consuming. It seems unreasonable that the burden of obtaining preauthorization for payment is on anyone other than the physician who will be performing and billing for the procedure.