Improving Clinical Information on Head CT Requisitions From the Emergency Department to Aid Interpretation and Billing Efficiency

AJR Am J Roentgenol. 2018 Jan;210(1):W18-W21. doi: 10.2214/AJR.17.18558. Epub 2017 Oct 24.


Objective: The accuracy of radiologic interpretations is higher when appropriate clinical information is provided, as is the likelihood of reimbursement for the studies. The purpose of this project was to evaluate and improve the quality of clinical information provided on head CT requisitions from an urban emergency department (ED).

Subjects and methods: In a prospective study conducted from July 2015 to May 2016, attending neuroradiologists evaluated 1100 randomly selected ED requisitions for unenhanced head CT, grading them for clinical and billing adequacy on a scale of 0-2. After acquisition of baseline data (400 studies), an intervention was performed that consisted of education of ED staff on the importance of clinical information in requisitions. A reminder slide was placed on a large screen in the ED staff working area with examples of appropriate history. Postintervention data (700 studies) were subsequently obtained. Mean scores and payment lag time before versus after the intervention were compared by Wilcoxon rank sum test.

Results: Statistically significant improvement was found in mean scores after the intervention for both clinical (1.32 to 1.43, p = 0.003) and billing (1.64 to 1.74, p = 0.02) adequacy categories. The percentage of studies with a score of 2 increased in both categories, and the percentages of 0 and 1 scores declined. There was a 21.1-day decrease in payment lag time (from 75.8 to 54.7 days, p < 0.0001).

Conclusion: The quality of clinical information provided on imaging requisitions by ED faculty and residents improved after a fairly simple intervention. Billing efficiency improved, and payment lag time decreased substantially.

Keywords: billing efficiency; clinical history.

MeSH terms

  • Brain / diagnostic imaging*
  • Data Accuracy*
  • Emergency Service, Hospital*
  • Humans
  • Insurance, Health, Reimbursement
  • Medical History Taking*
  • Prospective Studies
  • Quality Improvement*
  • Time Factors
  • Tomography, X-Ray Computed*