phrostomy, image guided percutaneous needJe biopsy,

and image guided percutaneous abscess drainages.

Any discussion of complications arising either fromthe procedure itself Ol' from radiation cannot be com­plete without recognition of two c1assic articles dealingwith complications of non-procedures, one by Baum,the other by Yarden. Both articles dealt with interven­

tional procedures that had been scheduled but canceled,but where patients nevertheless undelwent complica­

tions. This certainly supports the contention that certain

complications occurring after a procedure may not betrue complications of the procedure itself, but may either

be a coincidence, Ol' more likely, a complication of theprimary disease.

Sedation and AnalgesiaA 55-year-old patient undeJwent an MRI study and hadbeen given 4 mg Lorazepam priOl' to the examination.After the test was completed, the patient was asked to

remain at the radiology facility, but nevertheless left and

eL'ove horne in his car. During his travel, he crashed into

a pole, sustaining a tear of the aorta. A malpractice suitwas filed and a jUly awarded $1.5 million. Radiologistsshould be aware of the ACR Standard on Adult Sedation/Analgesia which states that written discharge instructions

to patients after sedation should include advice againstdriving Ol' operating dangerous machinery for a mini­mum of 12 hours.

Informed Consent and DisclosureThere are surprisingly few informed consent malpracticecases, as most interventional radiologists have familiar­ized themselves with the need to discuss with patientsthe nature of and the potential complications of an in­terventional procedure, the alternative options thatmight be explored, and the dangers of not performingthe procedure. RadioJogists must remember that it is thepatient who grants informed consenL and it is the patientwho can withdraw infOl'med consent. If during a proce­dure the patient demands that the procedure be stopped,the radiologist must adhere to the patient's demands andstop the procedure as soon as it is safe to do so.

lf complications do occur it is the radiologist's duty toinform the patient of the complication itself. When aphysician recognizes an error in the care of the patienthas occurred, disclosure should involve a straightfor­ward description of the nature of the mistake, its conse­quences, and corrective actions that will be taken. Ex­

pressions of remOl'se and an apołogy can be made, butthe radiologist should not admit personal fault Ol' bJameothers. Such admissions to a patient could Jater bebrought out in Court and be heJd against the radiologist.

4:15 p.m.CIRREF-Where are We and Where are We Going?josepIJ Bonn, MD

4:35 p.m.Avoiding the Top Ten Billing Mistakes in

Interventional RadiologyGary S. Doifman, MDHealtlJ Care Value Systems, Inc.

NortlJ Kingstown, R1

Learning ObjectivesUpon completion of the lecture, the attendee should be

able to:1. Understand the most common avoidable fiscal errors

in an lnterventional Radiology practice.

2. lmplement strategies to assess whether these errorsare occurring in the physician's practice.

3. Correct the discussed fiscal errors that are occurring inthe physician's practice Ol' access resources to assist inthe correction of these errors.

4. Establish proactive processes to prevent many of thecommon errors presented.lnterventional Radiology is one of the medical fields

most associated with high technology and innovation.However, it is both fortunate and unfortunate that thiswell-earned reputation does not carry over into the fiscaland business management of our practices. It is unfor­tunate in that our high technoJogy background shouldenable us to implement and utilize highly efficient com­puter-based tools to optimize our business practices. Wedo not accomplish this either well or often. lt is fortunatein that our Top Ten List in the area of practice misman­agement is much the same as a simiJar list that might beconstructed for any other specialty such as diagnosticradiology, surgery, or internaI medicine. Because of thatfact, the strategies necessary to deal with the root causesof our fiscal errors are well understood. In that regard,we do not have to reinvent the wheel. However, becauseof the diverse nature of our practices, the actual detaiJ ofhow one implements the strategies will be quite arcaneand partiCltlar to lnterventional Radiology.

I have constructed today's Top Ten List on the basisof data derived from HCVS' analysis of several millions ofc1aim lines from our c1ients' practices. The electroniclifetime of these c1aims encompasses the entire biJlingcycle from each claim's generation at the time of servicedelivery through the date of data extraction for ouranalysis; induding the steps of the initial biJI submission,all intercurrent transaetions such as denials and resub­missions, and the finał disposition including payments,adjustrnents, and/or write-offs. These data often do notpaint a pretty picture.

I must state at the outset that the data demonstratethat virtually every practice has its own unique problemsand, therefore, opportunities. So today's Top Ten Listwill not be in the correct order for any one practice-butwill instead be a compiJation of the ten most commonavoidable fiscal errors overall and in no particular order.We have also found that many of the fiscal errors thatmost practices suffer are indeed preventable and, even

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