What should this doctor's referral say instead?
March 17, 2015 12:46 AM Subscribe
My friend got a referral that seems wrong. Does it need to be corrected or is the radiology place we went to being picky?
So apparently the doctor my friend went to accidentally wrote on the referral paper "CT Brain" but the ct scan isn't supposed to be of the brain. It's supposed to be of the face and skull to check for facial trauma.
When we went to get the scan done the person at the desk told her that the referral says it's for the brain only. I'm guessing the doctor meant the entire head when he wrote brain, but the person at radiology is just wrong in her pickiness. Or do we need to go back to the doctor's office and have them replace "CT Brain" with "CT Head and Face" or "CT Face/Skull" or whatever it is they're supposed to write when the scan is for the face.
The scan is possibly going to be sent to a 3D printing center to make a mold out of her skull if we can manage it. If you have to get a CT scan, might as well get something cool out of it.
So apparently the doctor my friend went to accidentally wrote on the referral paper "CT Brain" but the ct scan isn't supposed to be of the brain. It's supposed to be of the face and skull to check for facial trauma.
When we went to get the scan done the person at the desk told her that the referral says it's for the brain only. I'm guessing the doctor meant the entire head when he wrote brain, but the person at radiology is just wrong in her pickiness. Or do we need to go back to the doctor's office and have them replace "CT Brain" with "CT Head and Face" or "CT Face/Skull" or whatever it is they're supposed to write when the scan is for the face.
The scan is possibly going to be sent to a 3D printing center to make a mold out of her skull if we can manage it. If you have to get a CT scan, might as well get something cool out of it.
All that is to say, for the insurance company, there is a world of difference between head/brain/skull.
posted by marsbar77 at 1:18 AM on March 17, 2015 [1 favorite]
posted by marsbar77 at 1:18 AM on March 17, 2015 [1 favorite]
The radiology center is not being picky. These are different procedures and need to be billed accurately.
This may cause problems with the insurance. You probably already know an insurance company will look for any reason to not pay a claim.
Chances are the radiology office will get a pre-auth (since it is a CT) from the insurance before they do the procedure, so if the insurance has an issue, they'll probably let your friend know before the CT takes place as opposed to after.
If this isn't the case, though, then this:
The insurance will look through all the documentation once they receive the claim and if the claims person catches that referral not matching the procedure, they can (read: will) deny it. Your friend can get the note re-written later and have the claim re-billed, but it's a big PITA for everyone involved.
Your best bet is to for your friend to get the doctor to rewrite the note before they set anything up with the radiology center ie before they submit anything at all to the insurance.
ps I used to work in a radiology office billing claims and handling denials.
posted by atinna at 2:41 AM on March 17, 2015 [7 favorites]
This may cause problems with the insurance. You probably already know an insurance company will look for any reason to not pay a claim.
Chances are the radiology office will get a pre-auth (since it is a CT) from the insurance before they do the procedure, so if the insurance has an issue, they'll probably let your friend know before the CT takes place as opposed to after.
If this isn't the case, though, then this:
The insurance will look through all the documentation once they receive the claim and if the claims person catches that referral not matching the procedure, they can (read: will) deny it. Your friend can get the note re-written later and have the claim re-billed, but it's a big PITA for everyone involved.
Your best bet is to for your friend to get the doctor to rewrite the note before they set anything up with the radiology center ie before they submit anything at all to the insurance.
ps I used to work in a radiology office billing claims and handling denials.
posted by atinna at 2:41 AM on March 17, 2015 [7 favorites]
Is there a chance that you could just call the doctor's office and have them send a revised referral through e-mail, fax, or phone? They should have your records, your friend is probably still relatively fresh in the doctor's mind, so a whole visit might not be necessary.
This is just a guess on my part -- I'm not a medical professional -- but it seems worth a phone call to find out.
posted by amtho at 4:23 AM on March 17, 2015 [3 favorites]
This is just a guess on my part -- I'm not a medical professional -- but it seems worth a phone call to find out.
posted by amtho at 4:23 AM on March 17, 2015 [3 favorites]
Best answer: I work for a radiology scheduling department. If they're looking at the skull, it would definitely be a CT Brain. The CT Brain is also known as ""CT Head" and essentially, either way you word it, it's the same exam.
If the trauma is closer to the front of the facial area, and more like the nose/mouth area, I would be concerned that they should also add a CT maxiollofacial, which basically scans the front of the face/eye area as well.
My suggestion is the call the office and speak to the referral coordinator about the concern. The area in which the doctor may be concerned will most likely be covered in the CT Brain/Head orders and thats why he only ordered it instead of both exams.
posted by Sara_NOT_Sarah at 1:03 PM on March 17, 2015 [1 favorite]
If the trauma is closer to the front of the facial area, and more like the nose/mouth area, I would be concerned that they should also add a CT maxiollofacial, which basically scans the front of the face/eye area as well.
My suggestion is the call the office and speak to the referral coordinator about the concern. The area in which the doctor may be concerned will most likely be covered in the CT Brain/Head orders and thats why he only ordered it instead of both exams.
posted by Sara_NOT_Sarah at 1:03 PM on March 17, 2015 [1 favorite]
Sara_NOT_Sarah is correct, but I will also add - you can generally see major facial trauma on a CT "brain" which does include the rest of the head. However, a CT "maxillofacial' or "CT max/face" or "CT facial bones" (it can be called any of these things depends on the facility) is protocoled differently, takes a more detailed picture of the facial bones and will pick up more subtle findings. It sounds like from what you're saying that the doc may have wanted the CT max/face instead of the brain, so I would definitely clarify the order before getting radiated. CT head or brain is mainly done looking for intracranial bleeding after trauma. Sometimes both studies are done if there is a high enough level of concern for both intracranial injury and facial bone fracture.
posted by treehorn+bunny at 7:30 PM on March 17, 2015 [1 favorite]
posted by treehorn+bunny at 7:30 PM on March 17, 2015 [1 favorite]
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posted by marsbar77 at 1:03 AM on March 17, 2015 [1 favorite]