[Jpersak]

Regarding CT r/o renal stone protocols (CT abdomen and pelvis without contrast) for initial diagnosis.

Is it advisable medical legally and/or  for coding/billing purposes to do any of the following alone or in combination.

1).  Decrease the scan coverage. e.g. cut off/not imaging the cephalad portion of liver and spleen.

2). Decrease mas/ technique. If so what amount is acceptable. What SD or noise level.

3). The need to specifically state any of the above in the report.

and

4). The need to Include any diagnostic disclaimer in the report if using 1 or 2 .

5). What would an example diagnostic disclaimer look like.

6). Is such disclaimer legally acceptable, coding acceptable and clinically/practically acceptable.

[Elliot K. Fishman, MD]

we scan for a stone protocol mid liver thru pelvis. We do not use disclaimers but if the patient has hematuria we would in the face of a negative stone study suggest that a contrast enhanced scan is needed to exclude non stone renal pathology.
as for dose we use a dose that is low but not so low that I would need a disclaimer in my report