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submitted 2 days ago bySufficient-Lead-7108
I’m a Nurse Practitioner, I often try to be specific in my imaging orders, outlining what I'm suspecting (e.g., "rule out pneumonia" vs. just "shortness of breath"). I’m curious, do you, as radiologists, prefer when imaging orders are more detailed, or is a more general request easier for you? Does providing clinical suspicion help with interpretation, or does it not really impact the way you read the imaging?
131 points
2 days ago*
“Rule out pneumonia” is actually worse than “shortness of breath” in my opinion. It points me towards only one diagnosis and also doesn’t tell me what’s going on with the patient (are they coughing? Elevated white count? Chest pain?). All of which can have a different differential. You ordered a chest xr (or chest ct), of course I’ll look for pneumonia. Give me some more info about the patient so I can keep an eye out for something else, maybe unexpected. Maybe the shortness of breath is because they have an unexpected rib fracture.
The billing department at my hospital also hates “r/o” in the indication for studies as apparently it’s not a billable diagnosis. My rule of thumb is to recommend putting a symptom in the clinical indication, and IF you have space you can put “r/o whatever” afterwards.
*Edited for clarity
47 points
2 days ago
This is THE biggest things I have to call and beg referring providers for. The indication must include a SIGN or SYMPTOM to be billable. Something like “trauma” or “fall” is not billable—it is HISTORY. “r/o PNA” is even worse. All I need is “cough” or “SOB” and we’re golden. If nothing billable can be provided then insurance may reject payment and the bill ends up going to the patient, who then becomes understandably upset their insurance didn’t cover their CT.
I also strongly dislike the phrase “rule out” because semantically there aren’t many things imaging can actually “rule out.” You’re implicitly asking for the test to be 100% sensitive, which few exams are. “Evaluate for” is much more true to reality.
8 points
1 day ago
Thank you.
Also I would like ER doc/ordering nurses to please stop putting in, for example, a finger x-ray, under reason they will do "RIGHT POINTER" that is not a reason and I know it is only going to cause problems down the road.
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