Radiologists from four academic radiology departments from around the U.S. have collaborated in publishing a comprehensive set of short, mid and long-term suggested strategies for coping with the global shortage of iodinated contrast agents in the journal Radiology. The journal has made the article available to all, and one hopes that this article will be widely read within the industry.

The authors note that current guidelines only allow for single puncture of intra-vascular contrast media (ICM) vials. If ICM shortages persist into and beyond the summer, they recommend that radiology leaders engage with the Centers for Disease Control and the Food and Drug Administration to consider pathways and mechanisms to permit or create multi-puncture ICM bottles, that will improve contrast access and reduce waste, while also preventing contamination. 

Modifications of use of ICM vials, of course, have billing and compliance ramifications. The authors believe that engagement with payers is necessary to assure both providers and payers agree on correct approaches to billing in order to prevent rejections of payment or delays in prior authorization. The strategy paper recommends that payers be made aware of likely increases in downstream MRI orders and pre-authorizations, and that the collective justification may help prevent delays and facilitate a more streamlined process. I understand that the American College of Radiology and the Radiology Business Management Association have begun such outreach to Medicare and other payers.

The academic radiologists also observe that most contrast-enhanced CT examinations result in the administration of and billing for only single-use vials as part of the exam, with anticipated waste of contrast with each study. But new workflows may cause use of a single-use vial for two examinations. The authors note that structuring ICM billing on a per mL instead of per vial basis would avert billing confusion as well as the potential for rejections of claims and the risk of billing fraud.

I am gratified to see that the strategies include the need to include the patient's treating physician in communications on which studies are performed and how they are designed. Radiology departments will be prudent to assure that treating physicians sign off on all radiology studies performed. Medicare rules require that only the patient's treating physician using the test results for the management of the patient can order the study. 

Good compliance and risk management policies during the contrast media shortage crisis will include careful documentation of the treating physician's role in the decision on which tests are performed and how they are designed.