Reimbursement for outside second opinion imaging interpretation: Experience at a quaternary care academic pediatric health system

Abstract

There are increasing requests and benefits of providing formal written reports for second opinions of outside imaging in part due to medical legal concerns supporting appropriate documentation and concerns that misunderstandings from verbal curbside consults on the part of the requesting physician may lead to suboptimal patient care and potential liability for the radiologist and hospital. Verbal communication of findings on outside imaging is thus often considered insufficient with recommendations from undocumented consultations less likely to be acted upon. The increased work associated with performance of second-opinion interpretations may be substantial, raising concern that if curbside consults are not properly compensated, some second opinion interpretations may be performed more expeditiously than primary interpretations due to their more direct impact upon the daily work load, income, and relative value units. Since 2016, our quaternary-care academic pediatric hospital system has provided and billed for formal second-opinion imaging interpretations upon request for MRI, CT, and Nuclear Medicine exams, and disallowed the process of informal curbside consultations on such studies. This study aims to offer insight into our second opinion interpretation workflows and our experience in obtaining reimbursement for pediatric second opinion interpretations. Our findings indicate a formal second-opinion interpretation program can be financially viable and may help offset the additional resources required, and can serve as a guide to inform other departments attempting to establish a similar process.