RGP Guidelines for Ordering Imaging Studies
Thank you for visiting this site. The impetus for creating this page
is a recent change in how orders for imaging studies are handled at
Western Baptist and Lourdes Hospitals.
Medicare rules do not allow any changes in the written order for an imaging study.
Therefore, when the order is not appropriate, the hospital will perform
an examination that is suboptimal, incomplete or in some cases cause the patient to receive
more radiation than necessary to answer the clinical question at hand.
The CMS rule is designed to prevent health care facilities from "upcoding", which is fraudulent.
In the past, the Radiologist would ask the hospital (through the technologist) to obtain
a new written order for an appropriate exam. This process is more cumbersome now because most
outpatient studies are pre-certified by Medicare and private insurance companies and will be
reimbursed only if the exact order is carried out. So to get a new order pre-certified, it means
additional delay and usually, rescheduling of the examination.
Remember that there are many protocols we use to obtain the best
and most appropriate examination for your patients. We follow
the guidelines of the American College of Radiology. Radiology Group of Paducah has over
150 years of collective experience in practicing Radiology and our
group has carefully tailored the best exams for your
patients, while observing strict standards regarding radiation safety.
You may order CT or MRI studies without specifying contrast need. If you do not specify
whether to administer contrast
Medicare allows us to select the most appropriate protocol. There is an exception: If you only order "CT Abdomen"
then no pelvis exam can be done. The most appropriate evaluation of the abdomen, i.e. for abdominal pain, is to include
the pelvis since these are anatomically contiguous. If you are concerned about appendicitis, an "Abdomen CT"
nondiagnostic because the area of concern is not imaged.
The abdomen technically is considered to extend from the diaphragm to the iliac crests only. The limits
of the pelvis are from the iliac crests to the pubic symphysis.
There are some studies that are virtually never indicated and should not be ordered:
1. Any MRI study ordered with contrast only (with no accompanying non-contrast images).
If you desire to know if there is abnormal contrast enhancement, order "MRI with & without contrast".
2. "High Resolution CT of the Chest with contrast." HRCT is a very specific exam to evaluate the lungs for interstitial
disease only and should never be ordered "with contrast". If more detailed information of a lung abnormality
is needed, order "thin section" images of the abnormality with a regular CT of the Chest, ideally,
3. CT of the Sinuses with contrast. There is usually no need to administer contrast for
a screening sinus CT (for sinusitis). Adding contrast un-neccessarily increases the risk to
the patient for an allergic reaction and generally provides no added information.
Please remember that we are always available for consultation in person or by telephone and
can be reached at Western Baptist Hospital at (270)575-2600 or at Lourdes Hospital (270)444-2177