Sources of Error or Confusion in Ordering Imaging Examinations and How to Avoid These Mistakes

Ordering an Examination as "Urgent" when the Designation of "Routine" is More Appropriate.

This situation pertains frequently to exams ordered in the emergency room. It is important for scheduling and reimbursement purposes to distinguish between real emergency situations and elective outpatient diagnostic evaluations, since insurance coverage may be denied for non-emergency care delivered in an emergent situation. This has the unfortunate effect of leaving the patient with a large unreimbursed expense and denying the institution revenue. It also delays the performance and interpretation of true emergency examinations, thus impeding the care of patients who truly require urgent care. Please carefully triage patients and schedule elective exams as outpatient procedures. For example, a patient with "weight loss for six months" is an outpatient case, not an emergency. A carefully designed elective workup may also result in less expensive care by utilizing appropriate screening tests such as PSA, fecal occult blood, mammography, and CXR to direct the evaluation, instead of immediately utilizing expensive imaging such as CT of the chest, abdomen, and pelvis, which has mortality and morbidity and may miss important disease like colon cancer.