Transfer patient imaging: secondary interpretation reimbursement

Area of Science:

• Radiology
• Healthcare Economics
• Trauma Care

Background:

• Trauma center radiologists' provision of secondary interpretations for advanced imaging in transferred patients varies.
• Uncertainty regarding reimbursement for these exams often leads to reluctance in performing routine overreads.

Purpose of the Study:

• To assess the difference in reimbursement rates between primary and secondary interpretations of advanced imaging within the emergency department (ED) setting.

Main Methods:

• Analysis of billing records for the three most common CT procedures in a Level 1 trauma center ED from January 1, 2021, to December 31, 2021.
• Data included gross charges, total receipts, and payer status for each exam.
• Reimbursement rates were calculated based on collected data.

Main Results:

• A total of 19,754 exams were analyzed; 83.6% were primary interpretations and 16.4% were secondary.
• The average reimbursement percentage was 32.9% for primary interpretations versus 43.5% for secondary interpretations across three CPT codes.
• Secondary interpretations showed higher reimbursement percentages across most payer types, including commercial, Health Insurance Exchange, and Medicaid.

Conclusions:

• Reimbursement for secondary interpretations of common CT exams in transferred trauma patients is comparable to or exceeds that of primary interpretations, irrespective of payer status.
• This suggests that financial concerns may not be a barrier to providing essential secondary interpretations.