ARRS 2022 Abstracts

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1170. Improving Reported Billable Indications for Radiology Exams
Authors * Denotes Presenting Author
  1. Brian Barnacle *; Dartmouth Hitchcock Medical Center
  2. Dave Sargent; Dartmouth Hitchcock Medical Center
  3. Sohum Patel; Dartmouth Hitchcock Medical Center
  4. Alicia Cloud; Dartmouth Hitchcock Medical Center
  5. Jocelyn Chertoff; Dartmouth Hitchcock Medical Center
  6. Alan Siegel; Dartmouth Hitchcock Medical Center
Objective:
Ordering clinicians of radiologic studies must document the patient’s signs and/or symptoms in a study request, not only for optimal interpretation by radiologists, but also to establish the medical necessity of the study for billing purposes. However, clinicians frequently order radiologic studies without providing a billable indication. As a result, institutions must devote resources to re-code radiologic study requests that were ordered without a proper indication. In a prior investigation, we determined that clinicians lack understanding as to what constitutes a billable indication. The goal of this quality improvement project was to improve clinician understanding of the proper billable indications for radiologic studies.

Materials and Methods:
A survey was emailed to all clinicians (attendings, residents, fellows, and associate providers) at our institution. The clinicians were provided with ten commonly used study indications and were asked whether or not they were billable. A quality improvement intervention was then implemented, in which all clinicians were sent an email summarizing the proper indications for a radiologic study. A follow-up survey was then emailed to all clinicians consisting of the same ten questions.

Results:
Respondents answered just over half of the questions correctly on the pre-intervention survey, with a mean score of 5.8 (questions answered correctly out of 10). After the intervention, the mean score among all respondents increased to 6.2 (p = 0.039). Additionally, the percentage of correct responses increased for 7 out of the 10 questions after the intervention, with no change in the percentage of correct responses for the other 3 questions. Notably, the percentage of responses correctly identifying that “? pneumonia” was an incorrect indication increased from 42% to 60%. Mean scores increased among attending physicians (6.4 to 6.6, p = 0.386), residents and fellows (5.2 to 5.7, p = 0.165), and associate providers (5.0 to 5.7, p = 0.056), but were not statistically significant likely due to small sample sizes.

Conclusion:
A proper indication for a radiologic study must include a sign or symptom that has been defined by several groups including the Centers for Medicare and Medicaid Services. A significant number of clinicians do not understand what constitutes a proper indication for ordering a radiologic study. Emails summarizing the proper indication of a radiologic study can have an educational impact on clinician understanding of billable indications.