Mid-South Imaging and Therapeutics, 6305 Humphreys Boulevard, Memphis, TN 38120, USA.
J Am Coll Radiol. 2010 Dec;7(12):931-6. doi: 10.1016/j.jacr.2010.05.026.
The aim of this study was to assess 15-year trends in nonprocedural clinical evaluation and management (E&M) services provided by interventional radiologists (IRs).
Medicare Physician Supplier Procedure Summary data from 1993 through 2008 were analyzed for changes in fee-for-service Medicare claims for nonprocedural clinical encounters (eg, consultations, rounds) provided by IRs. Current Procedural Terminology® E&M code 99201 to 99499 claims were extracted for IRs and analyzed for trends in volume, complexity, site of service, and payment denials.
Between 1993 and 2008, IRs' claims for E&M services increased by 1,200% (from 4,210 to 54,726), with increases in low-complexity (+1,384%, from 1,595 to 23,671), medium-complexity (+1,407%, from 1,386 to 20,884), and high-complexity (+728%, from 1,229 to 10,171) encounters. Volume increases were largest in the physician office setting (+2,298%, from 995 to 23,856) but also present in the inpatient (+1,112%, from 1,550 to 18,781), outpatient hospital (+492%, from 1,636 to 9,677), and miscellaneous (+8,217%, from 29 to 2,412) settings. Between 1993 and 2008, payment denial rates for IRs' E&M services declined from 22% to 11% (from 906 of 4,210 to 6,050 of 54,726, P <.001).
Interventional radiologist claims for nonprocedural clinical encounters with Medicare fee-for-service beneficiaries increased 12-fold over the 15 years from 1993 to 2008, as payment denial rates dropped by half. Evaluation and management services by IRs have grown fastest in the private office setting, which now represents the single most common location of these services.
本研究旨在评估介入放射医师（IR）提供的非手术临床评估和管理（E&M）服务在 15 年内的趋势。
对 1993 年至 2008 年 Medicare 医师供应商程序摘要数据进行分析，以了解 IR 提供的非手术临床（如咨询、查房）服务的按服务收费 Medicare 索赔的变化情况。提取了当前程序术语（CPT）E&M 代码 99201 至 99499 的索赔，并分析了数量、复杂性、服务地点和付款拒绝的趋势。
1993 年至 2008 年间，IR 提出的 E&M 服务索赔增加了 1200%（从 4210 到 54726），低复杂度（+1384%，从 1595 到 23671）、中复杂度（+1407%，从 1386 到 20884）和高复杂度（+728%，从 1229 到 10171）的索赔都有所增加。医生办公室的就诊量增幅最大（+2298%，从 995 到 23856），住院部（+1112%，从 1550 到 18781）、门诊医院（+492%，从 1636 到 9677）和其他（+8217%，从 29 到 2412）也有增加。1993 年至 2008 年间，IR 的 E&M 服务拒付率从 22%降至 11%（从 4210 例中的 906 例降至 54726 例中的 6050 例，P<.001）。
1993 年至 2008 年，介入放射医师向 Medicare 按服务收费受益人的非手术临床就诊提出的索赔增加了 12 倍，而拒付率则下降了一半。IR 的评估和管理服务增长最快的是私人诊所，现在这是此类服务的单一最常见地点。
