Hi everyone,

The following scenario was posed that pertains to ordering, performing, and billing for CT scans. The scenario as it was presented to me is below:

Patient will require two CT scans. One CT for the chest with contrast, and the second CT for the abdomen without contrast. Since both areas are close together, the scans will overlap as they are performed. I was asked how these two different procedures should be ordered and performed. My initial thoughts were because these are two separate tests with different requirements (one with contrast, one without) then two separate orders will need to be placed. Additionally, the scan without contrast should be performed first, then the second scan with contrast would be performed afterwards.

However, clinical staff expressed concerns that this process would expose the patient to double radiation, in addition to taking double the amount of time to complete. The clinicians asked whether the patient could be given the contrast, and the two scans would be performed as if both were ordered with contrast. This would allow for the scans to take place at once so the patient would not be exposed to radiation twice. My thoughts were that the procedure and medical record documentation would not support the original order of "no contrast" for the abdominal scan as the report generated from the scan would identify both scans taking place with contrast. Furthermore, billing for the procedures would then be inaccurate, as we would be billing for a procedure that was not performed, and additional risks may exist if there are negative findings of the scan performed in the area originally ordered without contrast. Furthermore, if both orders are submitted "with contrast" then we may have a difficult time proving medical necessity as the abdominal scan does not require the use of contrast. However, I understand that we would want to minimize the amount of radiation exposure to our patients, as well as keeping the patient visit to a short amount of time.

Has anyone had anything similar brought up at their facility? I do not have a clinical background, so understanding the daily operations in the Radiology Department can be challenging. As an FYI, I am in the Compliance Department at a large hospital system.

Thank you in advance for your guidance!