Many doctors and private hospitals are doing more CT scans on Covid patients than necessary, insurance companies and agencies that process hospital bills for insurance companies have said.
The agencies said they were often coming across cases where treatment sheets showed a patient was made to undergo multiple CT scans even though he had all parameters normal.
“We are raising queries in claims from hospitals where we feel the CT scan of thorax has been done more number of times than necessary. But we cannot interfere in the treatment. So, when the doctor is saying scans are necessary, we cannot do anything,” said Saurav Kariwala, assistant manager (medical), National Insurance Company Ltd, Calcutta. “Also, in these cases, if we deny the claim, the patient will suffer, not the hospital.”
An official of a third party administrator (TPA), which processes insurance claims, also said they were raising queries about such “excess CT scans” for Covid patients.
“We have come across cases where even though the stay of a Covid patient is as short as four to five days, two to three CT scans of thorax have been done,” said Jyotirmoy Kundu, network manager (hospitals) at Heritage Health TPA Pvt Ltd.
“In many cases we have found that the CT scan of thorax and the collection of swab samples for the RT-PCR test were done during admission. Which means the scan was done even before the results of the RT-PCR test came. Also, in several cases, while going through the treatment documents, we find that the patient is stable, his oxygen saturation is normal, there is no fever or breathing trouble, but still several CT scans of the thorax have been done,” said Kundu.
CT scans are way more expensive than X-rays. One private hospital in the city said their CT scan of the chest costs Rs 7,200, while X-ray of the chest costs Rs 500.
An official of a TPA said many doctors were getting the CT scan of the chest done for patients at the outpatients department without doing an RT-PCR test.
The American Colleges of Radiology, which represents about 40,000 radiologists in the US, has said CT scans and X-rays “should not be used as a first-time tool to diagnose or screen for Covid-19”.
It has given three reasons: A chest CT scan or X-ray cannot accurately distinguish between Covid-19 and other respiratory infections. Also, the CT scan or X-ray of many Covid patients can be normal, which can give a false impression that they are healthy. Besides, health workers can get exposed to the coronavirus while performing a CT scan on a Covid patient.
Doctors said the severity of a Covid patient’s condition depends on two factors — the oxygen saturation level and how much the lungs have been affected by the novel coronavirus, which causes Covid-19.
“The CT scan of the thorax gives a better image of the lungs. Initially, when RT-PCR tests were not available for most people, doctors were depending on CT scans to decide whether a person has any chance of having been infected by the coronavirus. But now RT-PCR tests are readily available and cheaper. It is a more accurate tool of diagnosis of Covid,” said Ajoy Krishna Sarkar, a critical care specialist.
“Repeated CT scans are hazardous for a patient. One CT scan leads to exposure to radiation of 100 X-rays,” said Sarkar.
Doctors treating Covid patients said diagnosis of the disease should not be based on radiology alone and that swab tests are necessary, too.
“A CT scan should not be part of the routine management of Covid. I get CT scans done on only those Covid patients whom I suspect might have a secondary bacterial infection, which the scan image can reveal. Also, I advise CT scans for patients who have suspected pulmonary embolism, which is a blockage in a pulmonary artery,” said Chandramouli Bhattacharya, an infectious diseases expert and member of the Covid treatment team at Peerless Hospital.
“The treatment of Covid depends on clinical features of the patient and blood tests.”
Arjun Alva, the administrative head of the medical intensive care unit and consultant in charge of Covid ICU at Narayana Hrudayalaya Health City, Bangalore, said less than 20 per cent of the patients in their ICU undergo CT scans.
“We do not do chest CT scans unless it is clinically required to rule out pulmonary embolism or for prognostication purposes,” he said. “We mainly depend on clinical features like whether the patient is able to maintain required oxygen saturation without oxygen support.”
He said CT scans at the Bangalore hospital were also done on patients who have to undergo a major surgery or procedure. “In 30 to 35
per cent cases, RT-PCR reports can be faulty. So for patients undergoing major surgeries or procedures, we do a CT scan. If the image of the lungs shows abnormalities, we defer the procedures,” said Alva.
Also, CT scans can be done on patients who are having all symptoms of Covid but the RT-PCR test is returning negative, he said.