Radiologists are performing more paracentesis, thoracentesis procedures

Radiologists are performing a larger share of paracentesis and thoracentesis procedures in Medicare patients, according to an analysis published Aug. 14 in the Journal of Vascular and Interventional Radiology.

Lead author Ravi V. Gottumukkala, MD, and colleagues studied Medicare patient-level claims data from 2004 to 2016. They found the proportion of paracentesis procedures performed by radiologists increased from 70% to 80% and thoracentesis procedures rose from 47% to 66%. 

“For both paracentesis and thoracentesis procedures, we observed an increase over time in the proportion of procedures performed by radiologists compared to non-radiologists,” Gottumukkala, a radiology fellow at Massachusetts General Hospital, said in a news release. “Additionally, while for both procedures, radiologists increasingly perform the majority of services on both weekdays and weekends, we found that the proportion of the services provided by radiologists was greater on weekdays compared to weekends.”

The researchers also analyzed the complexity of patients these procedures were performed in, finding that over the first nine years of the study, radiologists treated more complex patients. More recently, however, that complexity was similar for both radiologists and nonradiologists.

“The present findings suggest that previous implications from analyses of diagnostic imaging services, including the possibility of selective referral to radiologists of imaging studies performed off-hours and on more complex patients, do not apply to at least this subset of image-guided procedures,” the researchers wrote.

One of the “primary” limitations of the study, according to the researchers, were thoracentesis coding challenges experienced from 2008 to 2012. During that time period the CPT codes were used to code chest tube placement. The team said they did address the issue, but it is a problem that plagues all research utilizing claims datasets.

“Further study is warranted to determine what factors govern referral choices across the spectrum of image-guided procedures; how such choices impact cost, quality, and accessibility of care; and how best to incorporate these data into referral guidelines and emerging quality-based payment programs,” the authors concluded.