心脏 CT 和冠状动脉 CTA：全国和地区利用情况和覆盖范围的早期 Medicare 理赔分析。

Cardiac CT and coronary CTA: early Medicare claims analysis of national and regional utilization and coverage.

机构信息

Mid-South Imaging and Therapeutics, 6305 Humphreys Boulevard, Memphis, TN 38120, USA.

出版信息

J Am Coll Radiol. 2011 Aug;8(8):549-55. doi: 10.1016/j.jacr.2010.12.024.

DOI:10.1016/j.jacr.2010.12.024

PMID:21807348

Abstract

PURPOSE

The aim of this study was to assess trends in utilization and Medicare coverage of cardiac CT and coronary CT angiography (CCTA).

METHODS

Medicare claims for cardiac CT and CCTA were identified for the first 3 complete years for which Current Procedural Terminology(®) tracking codes existed (2006-2008). The frequencies of billed and denied services were extracted on national and regional bases, along with reporting physician specialty and site of service.

RESULTS

Total annual claims for cardiac CT and CCTA services for Medicare fee-for-service beneficiaries increased from 58,124 to 95,269 (+64%) between 2006 and 2008. The overall percentage of denied claims decreased from 34% to 21% (20,014 of 58,124 to 20,062 of 95,269, P < .001), with the highest denial rate for calcium scoring studies (declining from 82% to 61%) and the lowest rate for CCTA (29% to 14%). Annual overall regional denial rates ranged from 8.9% to 80.6%. Of all 254,672 base services, 138,136 claims (54%) were submitted by cardiologists, 90,767 (36%) by radiologists, and 13,445 (5%) by others. In 12,324 cases (5%), provider specialty was undetermined. Two-thirds (67%) of services were reported in the office setting (170,511), followed by the outpatient hospital (64,008 [25%]), inpatient hospital (15,922 [6%]), ER (1,577 [1%]), and all other (2,654 [1%]) settings.

CONCLUSION

Most cardiac CT and CCTA services are reported by cardiologists and most takes place in private office and outpatient hospital settings. During the first 3 years of Current Procedural Terminology tracking codes, the utilization of cardiac CT and CCTA by Medicare fee-for-service beneficiaries increased by 64%. Despite perceptions that new technology tracking codes are rarely payable, a large majority of all examinations are reimbursed by Medicare. Coverage varies regionally but overall has improved, setting the stage for expanded patient access.

摘要

目的

本研究旨在评估心脏 CT 和冠状动脉 CT 血管造影（CCTA）的使用和医疗保险覆盖情况的趋势。

方法

确定了 Medicare 对心脏 CT 和 CCTA 的索赔数据，这些数据是在前 3 年中存在当前程序术语（®）跟踪代码的情况下获得的（2006-2008 年）。根据国家和地区的计费和拒付服务的频率，以及报告医师的专业和服务地点提取数据。

结果

在 2006 年至 2008 年间，医疗保险付费受益人的心脏 CT 和 CCTA 服务的年度总索赔从 58124 增加到 95269（增加 64%）。拒赔率从 34%下降到 21%（20014 次/58124 次至 20062 次/95269 次，P<.001），其中钙评分研究的拒赔率最高（从 82%降至 61%），而 CCTA 的拒赔率最低（从 29%降至 14%）。每年的总体区域拒赔率范围从 8.9%到 80.6%不等。在所有 254672 个基本服务中，有 138136 个（54%）由心脏病专家提交，90767 个（36%）由放射科医生提交，13445 个（5%）由其他医生提交。在 12324 例（5%）中，医生的专业无法确定。三分之二（67%）的服务在办公室环境中报告（170511 例），其次是门诊医院（64008 例[25%]），住院医院（15922 例[6%]），急诊室（1577 例[1%]）和所有其他（2654 例[1%]）环境。

结论

大多数心脏 CT 和 CCTA 服务由心脏病专家报告，大多数发生在私人办公室和门诊医院环境中。在当前程序术语跟踪代码的前 3 年中，医疗保险受益人的心脏 CT 和 CCTA 的使用率增加了 64%。尽管人们认为新技术跟踪代码很少可支付，但绝大多数检查都由医疗保险报销。覆盖范围因地区而异，但总体上有所改善，为扩大患者获得服务奠定了基础。