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Letters Medicolegal—Malpractice and Ethical Issues in Radiology Routine Comparison Radiography of the Extremities: Should It Be Ordered and if so, How Should It Be Billed? QUESTION: Years ago, in my radiology practice, whenever a child underwent radiography because of an injury, comparison views of the opposite side were routinely ordered. In recent years, that practice has pretty much disappeared, I suppose for two reasons: the cost involved and the additional radiation exposure. Are you aware of any practice guidelines or rules that govern whether routine comparison views should be obtained? If so, can we bill for them? There is an orthopedic surgeon on our hospital staff who orders comparison radiographs every time he orders an examination of an extremity in a young patient. What is the correct method of billing for those services, if there is one? DR. BERLIN’S REPLY: I do not believe there are any formal or written indications, practice guidelines, or appropriateness criteria that focus on comparison views. Obviously, if there is a medical indication for obtaining the opposite-side radiographs in a specific case, then of course it would be legitimate to obtain them and the proper billing code should be applied.
You state that it’s the orthopedic surgeon who is ordering comparison radiography. I have to ask, “Why?” If there is a medical indication, then it should be documented, the radiographs should be obtained, and the appropriate charge should be applied. However, if the radiologist or orthopedic surgeon wants the opposite anatomic area radiographed for comparison purposes to render a more accurate interpretation, which may be quite legitimate for an infant or young child for whom having a comparison view is not only acceptable but necessary, then whether it can be billed and appropriately coded becomes a somewhat fuzzy situation. Frankly, I do not even put a charge through if I order comparison views to ensure the accuracy of my interpretation. Interestingly, I recently reviewed a medical malpractice case in which a dislocation of the elbow in a young child was missed, leading to permanent limitation of function and settlement of a malpractice lawsuit that had been filed against a radiologist. Had the radiologist asked for a comparison radiograph, I am sure the dislocation would not have been missed.
In summary, yes, radiologists can attempt to bill for comparison studies, but in many cases the claim will never be paid and time has been wasted. If I as the interpreting radiologist have the slightest question as to whether there is subtle fracture or dislocation in the extremity of a child, I believe ordering a comparison view is not only in the best interest of the child from a medical point of view but is also in my best interest from a medicolegal point of view. In such a situation, my practical advice is not to bill. Leonard Berlin NorthShore University HealthSystem, Department of Radiology, Skokie Hospital, Skokie, IL; Professor of Radiology, Rush University and University of Illinois, Chicago, IL ([email protected]) DOI:10.2214/AJR.13.11806 WEB—This is a web exclusive article.
F O R YO U R I N F O R M AT I O N
We invite your reply to this Medicolegal Q&A series. Send your questions and comments to the attention of AJR Q&A at [email protected]. The comprehensive and updated book, Malpractice Issues in Radiology, 3rd edition, by Leonard Berlin, is now available! For more information or to purchase a copy, see www.arrs.org.
All opinions expressed herein are those of the author and do not necessarily reflect those of the American Journal of Roentgenology or the American Roentgen Ray Society. This monthly column answers common professional liability questions. The legal advice provided herein is intended to be general in nature and in specific circumstances is not a substitute for formal legal opinions obtained from the reader’s personal legal counsel. AJR 2014; 202:W182 0361–803X/14/2022–W182 © American Roentgen Ray Society
W182
AJR:202, February 2014
Letters Medicolegal—Malpractice and Ethical Issues in Radiology Routine Comparison Radiography of the Extremities: Should It Be Ordered and if so, How Should It Be Billed? QUESTION: Years ago, in my radiology practice, whenever a child underwent radiography because of an injury, comparison views of the opposite side were routinely ordered. In recent years, that practice has pretty much disappeared, I suppose for two reasons: the cost involved and the additional radiation exposure. Are you aware of any practice guidelines or rules that govern whether routine comparison views should be obtained? If so, can we bill for them? There is an orthopedic surgeon on our hospital staff who orders comparison radiographs every time he orders an examination of an extremity in a young patient. What is the correct method of billing for those services, if there is one? DR. BERLIN’S REPLY: I do not believe there are any formal or written indications, practice guidelines, or appropriateness criteria that focus on comparison views. Obviously, if there is a medical indication for obtaining the opposite-side radiographs in a specific case, then of course it would be legitimate to obtain them and the proper billing code should be applied.
You state that it’s the orthopedic surgeon who is ordering comparison radiography. I have to ask, “Why?” If there is a medical indication, then it should be documented, the radiographs should be obtained, and the appropriate charge should be applied. However, if the radiologist or orthopedic surgeon wants the opposite anatomic area radiographed for comparison purposes to render a more accurate interpretation, which may be quite legitimate for an infant or young child for whom having a comparison view is not only acceptable but necessary, then whether it can be billed and appropriately coded becomes a somewhat fuzzy situation. Frankly, I do not even put a charge through if I order comparison views to ensure the accuracy of my interpretation. Interestingly, I recently reviewed a medical malpractice case in which a dislocation of the elbow in a young child was missed, leading to permanent limitation of function and settlement of a malpractice lawsuit that had been filed against a radiologist. Had the radiologist asked for a comparison radiograph, I am sure the dislocation would not have been missed.
In summary, yes, radiologists can attempt to bill for comparison studies, but in many cases the claim will never be paid and time has been wasted. If I as the interpreting radiologist have the slightest question as to whether there is subtle fracture or dislocation in the extremity of a child, I believe ordering a comparison view is not only in the best interest of the child from a medical point of view but is also in my best interest from a medicolegal point of view. In such a situation, my practical advice is not to bill. Leonard Berlin NorthShore University HealthSystem, Department of Radiology, Skokie Hospital, Skokie, IL; Professor of Radiology, Rush University and University of Illinois, Chicago, IL ([email protected]) DOI:10.2214/AJR.13.11806 WEB—This is a web exclusive article.
F O R YO U R I N F O R M AT I O N
We invite your reply to this Medicolegal Q&A series. Send your questions and comments to the attention of AJR Q&A at [email protected]. The comprehensive and updated book, Malpractice Issues in Radiology, 3rd edition, by Leonard Berlin, is now available! For more information or to purchase a copy, see www.arrs.org.
All opinions expressed herein are those of the author and do not necessarily reflect those of the American Journal of Roentgenology or the American Roentgen Ray Society. This monthly column answers common professional liability questions. The legal advice provided herein is intended to be general in nature and in specific circumstances is not a substitute for formal legal opinions obtained from the reader’s personal legal counsel. AJR 2014; 202:W182 0361–803X/14/2022–W182 © American Roentgen Ray Society
W182
AJR:202, February 2014
