MSK ultrasound code tweak curbed clincians' overuse, analysis finds

Growing concerns over the ballooning use of ultrasound to examine arm and leg tissue led lawmakers to take action in 2011, dividing reimbursement codes for these procedures. But did their changes put an end to this troubling trend?

New research published March 2 in Current Problems in Diagnostic Radiology indicates that, yes, the approach did work. A team from Harvey L. Neiman Health Policy Institute analyzed mounds of current procedural terminology code data and found that non-vascular extremity ultrasound imaging tapered off after these billing adjustments went into effect.

“Prior rapid growth in extremity nonvascular US for podiatrists slowed considerably following CPT code separation in 2011,” wrote Andrew Rosenkrantz, MD, director of health policy in the department of radiology at NYU Grossman School of Medicine. "Subsequent service growth has largely been related to less costly, focused examinations performed by radiologists."

Between 1994 and 2010, private practice podiatrists’ use of nonvascular extremity ultrasound increased dramatically—to the tune of 87% annually. Self-referral was thought to be a large driver of this growth and was beginning to draw the ire of payers. By comparison, during that same time period, radiologists’ utilization jumped by 6% annually.

Then in 2011, the CPT Editorial Panel divided coding for these exams into two separate buckets—one for complete exams and another for the limited variety. A code used for the latter was created for “focused evaluation of an anatomic structure,” such as a specific muscle or tendon. Use of complete exam coding, on the other hand, was reserved for “comprehensive” joint exams assessing all soft-tissue surrounding a particular region.

“One goal of the code separation was to recognize focused point-of-care ultrasounds by certain specialties as distinct from the more complete examinations typically performed by radiologists,” the authors noted.

After analyzing Physician/Supplier Procedure Summary Master Files and CPT codes, Rosenkrantz et al. found podiatrists’ utilization leveled off after 2011, growing a mere 0.4% for complete exams and 0.6% for limited ones. Meanwhile, radiologists’ use of such testing increased by 3% and 12% annually for complete and limited exams, respectively.

Additionally, the authors noted that these private practice high-utilizers’ market share fell to 14% in 2017, down from its peak of 31% in 2009. For radiologists, that figure decreased from 73% to 40% over the same time frame.

“The observation indicates how regulatory action can serve as a strong driver of physician behavior, in turn influencing patient care,” the authors wrote. “For this particular regulatory action, the resulting change may be viewed as a success from the perspective of federal policymakers seeking to control healthcare spending: continued growth of potential self-referral essentially ceased, and the continued growth by radiologists largely comprising the less-costly limited exam.”