CT code bundling rocks radiologist reimbursements

The bundling of reimbursement codes for CT of the abdomen and pelvis in 2011 hit medical imaging hard, resulting in a 29 percent decrease in reimbursements for the exams in 2011, according to a study published in the May issue of the American Journal of Roentgenology.

For the study, David C. Levin, M.D., Vijay Rao, M.D, and Laurence Parker, Ph.D., looked at nationwide Medicare Part B data files from 2001 to 2011 to select codes for CT of the abdomen and pelvis before and after bundling occurred in 2011. From this the authors calculated utilization rates per 1,000 Medicare beneficiaries.

While use of CT of the abdomen and pelvis remained approximately same in 2011 (after bundling) as in 2010 (before bundling), the actual rate per 1,000 decreased from 277.1 to 148.1 per 1,000 beneficiaries because the two codes were bundled.

While the data showed that Medicare reimbursements for use of CT for the abdomen and pelvis rose steadily from 2001 to 2005, it remained relatively stable after that through 2010. However, after the codes were bundled, reimbursements decreased 29 percent--from $971.5 million in 2010 to $687 million--with radiologists bearing $218.8 million of the decrease.

Levin and his colleagues identified this as another example of how medical imaging is being rocked by reimbursement reductions.

"[This CT code bundling] is another example of a major cut, the magnitude of which may not have been fully anticipated," they wrote. "Although CMS will see this as helpful in their efforts to reduce healthcare costs, it could also lead to an adverse outcome--a loss of patient access to CT if payments continue to be reduced to the point at which providers can no longer cover their costs."

The authors pointed out that code bundling continues to be implemented, which will lead to further reductions in radiology and medical imaging reimbursements.

The 2014 Medicare Physician Fee Schedule (MPFS) final rule contains six new codes that bundle breast biopsy with the imaging guidance used--either stereotactic, ultrasound, or MRI--each with an add-on code to describe additional lesions. These new codes will result in reimbursement cuts ranging from 29 to 54 percent.

To learn more:
- see the study in the American Journal of Roentgenology

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