Radiology in the cross hairs: reimbursement and radiologists

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CHICAGO, Nov. 28—“If you’re not at the table, then you’re on the menu,” warned Chris Ullrich, MD, chair of the American College of Radiology (ACR) managed care committee and managed care network. RSNA, in conjunction with ACR, tackled the tough topic of radiologists’ pay during a Tuesday morning refresher course.

Coding 101

Richard Duszak, MD, chair of ACR committee on coding and nomenclature, reviewed the latest in coding initiatives and advocacy. Established radiology codes mainly fall in category 1 and have a high threshold, requiring wide acceptance in the medical community and peer-reviewed literature establishing the utility of the procedure. Category 3 codes, on the other hand, carry a lower threshold. New technologies like cardiac CT and CT colonography fall into category 3.

Duszak described cardiac CT as a coding work in progress. With increased utilization of the technology, ACR initiated new coding and recommendations, aiming to move cardiac CT from category 3 to category 1 status. A similar pattern of increased utilization exists with CT colonography, but disagreements between ACR and gastrointestinal societies muddy the waters and need to be resolved before new codes are implemented. 

Duszak reminded the audience that new codes are not the end product of the coding process. “ACR needs to ensure that payers correctly reimburse physicians,” said Duszak. Radiologists can facilitate the payment process by encouraging radiology certification among coders.

CMS, Medicare and radiology

The current Centers for Medicare and Medicaid Services (CMS) environment is far from favorable for radiologists. The budget neutral adjustment reduces physician work component of Medicare payments, and radiology remains in the cross hairs for future cuts, said Bibb Allen, MD, vice chair of ACR commission on economics. Allen warned that Medicare debt may require a complete overhaul of Medicare system.

There are few bright spots on the horizon. Payments for CT and MRI should increase over the next four years.

On the downside, disruptions to the valuation process—competition for healthcare resources, flawed CMS funding formulas and DRA—create a challenging environment. ACR will continue to advocate for the profession by focusing on quality and accreditation and remaining proactive on pay for performance, said Allen.

John Patti, MD, chair of ACR commission on economics, shared several case studies to demonstrate the value of ACR advocacy. Consider cardiac CT and CT angiography, technologies that secured coverage at local levels. CMS challenged the valuation and plans to issue a draft national coverage determination (NCD) based on limited data that fails to fully demonstrate the utility of 64-slice cardiac CT on Medicare-aged patients. ACR continues to share current literature studies with CMS and will respond with an appropriate strategy after the NCD draft is released on Dec. 13.

In other cases, ACR effectively reversed single payer decisions that cut payments to radiologists for services like mammography CAD. “Radiologists can set the stage for fair and prompt reimbursement by participating in ACR and payer advisory committees, implementing sound technical/professional billing, supporting Radiology Business Managers Association (RBMA) and engaging in legislative advocacy,” concluded

Chris Ullrich, MD, chair of ACR managed care committee and managed care network.