As interventional radiology (IR) becomes a more clinically oriented specialty, understanding the financial aspects of evaluation and management (E/M) billing including average submitted charges and trends in reimbursement rates can provide valuable information to IR physicians and the specialty.

The use of percutaneous ablative techniques in the treatment of a variety of cancers and benign tumors is well documented with research supporting effective outcomes in appropriately selected patients. The following provides an overview of ablations performed for Medicare Beneficiaries by organ system.

A subset of trauma patients with active contrast extravasation on initial portal venous (PV) CT imaging may undergo a second scan with CT arteriography (CTA) to distinguish between arterial and venous etiologies. This study investigates the effect of pre-procedural CTA in trauma patients on intraprocedural angiography metrics.

To describe a novel lymphatic imaging technique: pediatric ultra-high resolution CT lymphangiography (UHR CTL) with water-soluble iodinated contrast via direct inguinal intranodal injection. UHR CTL is particularly beneficial in complex congenital heart disease patients with postoperative high-mortality continuous chylothorax and right-to-left shunt.

Radiologists, both Diagnostic and Interventional, perform a variety of percutaneous musculoskeletal (MSK) procedures that are shared by other specialties, including bone ablations, bone marrow aspirations/biopsies, vertebroplasty/kyphoplasty, and bone/soft tissue biopsies. Limited data exists on trends and specialty involvement for these procedures.

Peripheral nerve blocks (PNBs) confer multiple benefits including reduced postprocedural pain and more rapid post-procedural recovery. While traditionally used for surgical procedures, they offer potential benefits for interventional radiology (IR) patients. No current data exists regarding the number and type of nerve blocks performed by IR physicians among Medicare patents.

Investigate the degree to which morbidity and mortality (M&M) conferencing is utilized in interventional radiology (IR), identify impediments to its adoption, and assess the experience of those using this tool.

As interventional radiology (IR) becomes a more clinically oriented specialty, a reasonable metric of clinical activity is billing of evaluation and management (E/M) services among Medicare patients. The following provides a trend analysis for E/M billing among IR physicians.

Bone marrow aspiration and bone marrow biopsies can help guide diagnosis and treatment for a variety of disorders. These procedures have traditionally been done by Hematology/Oncology (Hem/Onc). Among Medicare Patients, minimal data exists on trends in procedure volume and specialty involvement.

To identify the volume of diagnostic vascular imaging studies (CTA/MRA/US) interpreted by interventional radiologists in comparison to other medical specialties. The Medicare Physician and Other Supplier Public Use File claims were used to categorize radiologists whose practice was interventional radiology by identifying radiologists with the majority of their wRVUs from interventional codes according to the NITOS classification system. Vascular imaging was defined by HCPCS billing codes for all diagnostic vascular studies including CTA, MRA, and vascular ultrasound studies of the head, neck, chest, abdomen, pelvis, and extremities. Importantly, physicians not submitting at least 10 claims for any particular code were excluded from the database for that specific HCPCS code per CMS data policy. A total of 2251 radiologists submitted the majority of their wRVUs under interventional codes and were identified as interventional radiologists. Of these, 366 interpreted a sufficient number of vascular imaging studies to be included in the dataset, while 1885 IR physicians interrupted less than 10 studies for all vascular imaging codes during the 2017 calendar year. For the 366 IR physicians included in the study, 58,345 (1.60%) of the total 3,656,480 diagnostic vascular imaging studies performed were interpreted by dedicated IRs. In comparison, radiologists with the majority of their wRVUs in non-interventional codes interpreted 52.3% of vascular studies. Vascular Surgery and Cardiology interpreted 16.1% and 12.3%, respectively. There was a statistically significant difference in rate of vascular imaging interpretation among frequent providers between IR and Vascular Surgery which recorded an average of 159 and 638 studies read per physician in 2017 respectively (P < 0.01). The majority of interventional radiologists do not interrupt or perform a low number of diagnostic vascular imaging studies for Medicare patients. These findings have important implications for the potential management, referral patterns and training of IR physicians.

As the field of interventional radiology (IR) continues to evolve, the number of patients being managed pre and postprocedurally by IR physicians will increase. Pain management especially for chronically ill patients, is a critical part of appropriate patient care. Previous studies have shown broad variability in opioid prescription rates among different states and for individual procedures. This study compares the opioid prescriber rate (OPR) among different physician specialties including IR on a national and state level using Medicare data. The Part D Prescriber Public Use File provides information on prescription drugs prescribed by individual physicians and other health care providers under the Medicare Part D Prescription Drug Program. To be included in this database, providers must submit more than 10 drug-related CPT-specific codes. As a result, the database only reflects the prescription pattern for frequent providers. Data from 2013-2017 was used to determine the opioid prescriber rate (OPR) defined as the total number of opioid claims divided by the total number of drug claims per provider. At the national level, the opioid prescription rate by frequent providers in 2017 varied from 0.24% for cardiology to 58.4% for pain medicine. IR and Surgery had an overall OPR of 10.7% and 21.8% in 2017 respectively compared to 7.9% and 21.9% in 2013. There was significant state-wide variability in opioid prescription rates for IR, Surgery, and Pain Medicine. For IR, frequent providers in Mississippi had an OPR of 58.8% while in Hawaii no interventionalist prescribed more than 10 opioid prescriptions for Medicare beneficiaries. Table 1 displays national and state OPR rates by speciality. The Opioid Prescription Rate (OPR) is a tool to evaluate the prescription patterns of different specialties. In the current opioid epidemic, evaluation of the factors that affect opioid prescription is critical. Although IR currently prescribes only a small percentage of the total opioid claims, these numbers are likely to increase moving forward. Developing national guidelines could potentially decrease the significant local and national variability in the use of narcotics.Table 1National and State Variability in Opioid Prescription Rate (OPR) by SpecialtySpecialtyNational OPR 2013National OPR 2017Max OPR by State 2017Min OPR by State 2017Medicine5.0%4.1%6.90% (OK)2.10% (NY)IR/DR7.9%10.7%58.8% (MS)0% (HI/ME/DE)Surg/VS21.9%21.8%41.5% (MS)8.7% (NM)Card/IC0.4%0.24%1.4% (DC)0% (VT/NE)Hem/Onc13.3%10.8%18.4% (AL)4.7% (SD)Pain56.7%58.4%67.2% (SD)14.6% (ME) Open table in a new tab

Studies have shown that physicians have a limited understanding of the financial aspects of their interventions. This is especially true for trainees who often receive minimal education on the matter. To improve the understanding of interventional radiology (IR) residents and fellows, we evaluated physician professional fees in the facility setting, global fees in the office setting, and Medicare reimbursement for 10 of the most commonly performed IR procedures. Data was also included on the percentage of each procedure being performed by an IR physician. The 2016 "Medicare Provider Utilization and Payment Data: Physician and Other Supplier" database was used to extrapolate information regarding providers, type of service, average submitted fee for a service, and average Medicare reimbursement in the "facility" or "office" setting. For this study, we focused on tunneled catheter placement, port placement/removal, fistulogram, venous thrombectomy, venoplasty, venous stenting, IVC filter placement/removal, and tumor embolization. Table 1 summarizes the mean (SD) facility professional fee, mean (SD) office global fee, and mean (SD) Medicare reimbursement. Professional and global fees exhibited broad variability. For example, the mean professional fee for a port removal was 845 with a SD of 345 while IVC filter placement was 2,127 with a SD of 2,835. Overall, 57% of the investigated procedures in the facility setting was performed by IR versus 25% in the office setting. The role of IR varied from 99% (tumor embolization) to 36% (venous stenting) in the facility setting versus 100% (tumor embolization) to 21% (tunneled catheter placement) in the office setting. Knowledge of procedural fees can benefit physicians, especially trainees. It is important for practice development, cost conscious decision making, and patient education. Currently, there is large variability in professional/global fees and IR physician involvement for the evaluated procedures. Mean professional and global (SD) fees, mean (SD) Medicare reimbursement, and the percentage of each procedure performed by IR physicians is provided in table 1 for review.Table 1Mean Professional Fees (SD), Global Fees (SD), and Medicare Reimbursement (SD) for Common IR ProceduresProcedureFacility SettingOffice Setting# IR Providers(PPIRP)Mean (SD) Professional FeeMean (SD) Medicare Reimbursement# IR Providers(PPIRP)Mean (SD) Global FeeMean (SD) Medicare ReimbursementTunneled catheter placement2350 (66%)1456 (938)221 (18)62 (21%)2192 (660)569 (73)Port placement1882 (48%)2012 (1426)288 (22)136 (67%)3537 (1486)817 (279)Port removal354 (55%)835 (345)157 (15)38 (32%)895 (336)217 (38)Fistulogram1562 (57%)1041 (836)89 (11)266 (24%)2178 (734)380 (90)Thrombectomy370 (67%)1965 (1618)199 (28)128 (22%)5091 (1354)1313 (199)Venoplasty1184 (55%)1862 (1536)181 (18)240 (23%)3977 (1464)953 (207)Venous stenting128 (36%)2404 (3385)240 (19)103 (23%)11,526 (3357)3519 (487)IVC filter placement528 (75%)2127 (2835)192 (17)1 (50%)11,1842044IVC filter removal28 (78%)2846 (2265)295 (24)2 (67%)5469 (2113)1102 (17)Tumor embolization273 (99%)8196 (11,736)482 (39)10 (100%)22,004 (12,922)6563 (3310)PPIRP = percent performed by IR physicians. Calculated by dividing the number of procedures performed by IR physicians by the total number of procedures performed by all providers (includes radiologists, vascular surgeons, interventional cardiologists, and others). Open table in a new tab