Ultimately, of the 286 exams submitted, 260 (91%) were reimbursed for professional fees, 199 (70%) on the initial submission. The remaining 286 exams (77%) were submitted for reimbursement of the professional fee only. Forty-one of 370 exams (11%) were submitted for self-pay, and 43 (12%) were written off as free care. Head CT was the most common imaging exam referred for second opinion.

Formal second-opinion interpretation was rendered for 370 exams on 198 patients (mean age, 53.5 years 45.1% female), received from 50 referring facilities. This quality assurance exercise was reviewed by our institutional review board, which waived formal informed consent. Discrepancies between outside and second-opinion interpretations were also assessed. A more in depth review was performed of those exams for which a clinical referral request form was available, detailing such information as the clinical history, content and source of available initial interpretation, and congruity of the initial interpretation with clinical data. Second-opinion interpretations of cross-sectional imaging exams rendered in the emergency department setting over 6 months spanning 22 September 2009 to 22 March 2010 were reviewed and tallied by two radiologists and a research assistant, with a focus on professional fee reimbursement rates. The purpose of this study is to describe a system for formally reporting second-opinion interpretations of CT imaging exams accompanying patients transferred emergently to a tertiary care center.