2017-07-14 11:48:47 - 8

The importance of understanding the structure of Radiology and Diagnostic Imaging exams

The best-known tables used as a reference in the Brazilian market in the supplementary health segment are: the Brazilian Hierarchical Classification of Medical Procedures (CBHPM), Unified Supplementary Health Terminology (TUSS) and Rol of the National Supplementary Health Agency (ANS) to determine coverage mandatory minimum of procedures. There are no overlapping exams in any of them, that is, when requesting an exam the other is not automatically contemplated. The entire structure of exams in Brazilian supplementary health is composed of exams with specific purposes and without overlapping. Sometimes, on the part of lay people, there is an incorrect understanding that, due to the fact that the area examined is close to or partially captured in the image of the examination, the radiologist should examine it and report it regardless of whether it was requested in the request for the examination. requesting physician. Often, radiologists capture images adjacent to the requested exams because there may be some anomalies that interfere with the report of the requested exam, but this does not mean that they are doing or that they should do an analysis in these adjacent areas and issue a report on the adjacent parts. When the requesting physician makes the medical request, he has a specific purpose and a diagnostic hypothesis. This request serves to guide the radiologist when performing the exam. No exam authorized and performed by the radiological clinic could be excluded, merged with another exam or have its code changed by the paying source. Such practices are irregular as understood by the CBR and the TISS standard itself, which does not provide for this type of manipulation. The example above was rescued from the queries we received at CBR about bad practices from paying sources, which, in order to pay less, create justifications without any medical basis or support from CBR. It is worth noting that these procedures are already extremely outdated in values. We strongly recommend that you do not accept such or similar practices, as this type of distortion harms all colleagues and generates distortions in the market. Remember that the descriptions of the procedures are not free and do not follow the will of each health care provider, but are governed by the ANS and must follow the current TUSS table standard, regardless of the table of values that the health care provider in question uses as reference. Carlos Moura Economic Advisor at CBR