Department of Radiology, Duke Health System, Durham, NC.
Department of Radiology, Massachusetts General Hospital, Boston, MA.
Curr Probl Diagn Radiol. 2021 May-Jun;50(3):337-343. doi: 10.1067/j.cpradiol.2020.02.008. Epub 2020 Mar 2.
Concerns regarding increasing utilization of non-vascular extremity ultrasound (US) imaging led to the Current Procedural Terminology (CPT) Editorial Panel separating a singular billing code into distinct comprehensive and focused examination codes with differential reimbursement. We explore this policy change's temporal association with utilization.
Using Physician/Supplier Procedure Summary Master Files, we identified all nonvascular extremity US services billed for Medicare fee-for-service beneficiaries between 1994 and 2017. These included generic (CPT code 76880 from 1994 to 2010), complete (code 76881 from 2011 to 2017), and limited (code 76882 from 2011 to 2017) examinations. Annual utilization per 100,000 beneficiaries was computed and stratified by billing specialty. Compound annual growth rates were calculated.
Radiologists and podiatrists were the top 2 billing specialties for nonvascular extremity US examinations. From 1994 to 2010, radiologist services increased 6.1% annually. Following the 2011 code separation, radiologists' utilization increased 2.7% annually for complete and 12.3% for limited exams. Between 1994 and 2017, radiologists' market share decreased 72.8% to 40.4%. From 1994 to 2010, podiatrist services increased 87.1% annually. Following the code separation, podiatrists' annual utilization growth stabilized 0.4% for complete and 0.6% for limited exams. Podiatrists' market share was 9.1% in 2001, peaked at 31.3% in 2009, and declined to 14.3% in 2017.
Prior rapid growth in extremity nonvascular US for podiatrists slowed considerably following CPT code separation in 2011. Subsequent service growth has largely been related to less costly, focused examinations performed by radiologists. Further study may help better understand how CPT coding changes alter imaging utilization more broadly.
由于对外周非血管超声（US）成像利用率不断提高的担忧，当前的操作术语（CPT）编辑小组将单一计费代码分为具有不同报销额的全面和重点检查代码。我们探讨了这一政策变化与使用率之间的时间关联。
我们使用医生/供应商程序摘要主文件，确定了在 1994 年至 2017 年期间向 Medicare 按服务收费计划的受益人开具的所有外周非血管 US 服务。这些服务包括通用（1994 年至 2010 年的 CPT 代码 76880）、全面（2011 年至 2017 年的代码 76881）和有限（2011 年至 2017 年的代码 76882）检查。按计费专业计算每 100,000 名受益人的年度使用率，并进行分层。计算了复合年增长率。
放射科医生和足病医生是外周非血管 US 检查的前 2 大计费专业。从 1994 年至 2010 年，放射科医生的服务每年增长 6.1%。在 2011 年代码分离后，放射科医生的全面和有限检查的使用率每年分别增加 2.7%和 12.3%。1994 年至 2017 年期间，放射科医生的市场份额从 72.8%下降到 40.4%。1994 年至 2010 年，足病医生的服务每年增长 87.1%。代码分离后，足病医生的年度使用率增长率稳定在全面检查为 0.4%，有限检查为 0.6%。足病医生的市场份额在 2001 年为 9.1%，在 2009 年达到 31.3%的峰值，在 2017 年下降到 14.3%。
在 2011 年 CPT 代码分离后，足病医生对外周非血管 US 的快速增长明显放缓。随后的服务增长主要与放射科医生进行的成本较低、重点检查有关。进一步的研究可能有助于更好地了解 CPT 编码变更如何更广泛地改变成像利用率。
