From the Guidelines
Another preauthorization is typically needed when a radiologist changes a CT scan from "with contrast" to "with and without contrast" to ensure proper coverage and reimbursement. This is because insurance companies generally consider these as different procedures with different billing codes and medical necessity requirements. The change involves additional contrast administration, increased radiation exposure, and higher costs, which insurers want to review before approving 1. To handle this situation, the imaging facility or ordering physician should contact the insurance company to modify the existing authorization or request a new one before performing the modified scan. Some key points to consider include:
- The use of intravenous contrast in CT scans is generally recommended, unless there are contraindications such as contrast allergy or renal insufficiency 1
- Performing a CT scan with and without contrast may be necessary in certain situations, such as suspected contained rupture, but this should be done with caution and consideration of the increased radiation exposure 1
- Regulatory agencies, accrediting bodies, and third-party payers all have important roles to play in reducing unnecessary radiation exposure, and the American College of Radiology has made recommendations to support these efforts 1 The safest approach is to secure proper authorization for the modified procedure before proceeding with the scan to ensure proper coverage and reimbursement.
From the Research
Preauthorization for CT Scans with Contrast
- When a preauthorization is provided for a study like a CT scan and the radiologist simply changes from with contrast to with and without contrast, the need for another preauthorization is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, it is essential to consider the medico-legal implications of using contrast media, including informed consent and the potential risks and benefits of the procedure 2.
- The management and prevention of hypersensitivity reactions to radiocontrast media are crucial, and guidelines have been developed to standardize the care of patients who experience or have a history of reaction to contrast media 3.
- Updated guidelines for intravenous contrast use for CT and MRI scans emphasize the importance of using contrast media safely and with fewer precautions than with prior guidelines 4.
- Practical guidelines for the use of contrast media highlight the need for careful risk-benefit analysis, especially in patients with reduced renal function, pregnancy, lactation, and the pediatric population 5.
- A survey study on contrast medium protocols in routine chest CT scans found that protocols and strategies for contrast medium administration vary widely, affecting image quality 6.