Fourth-Year Medical Student, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Radiology Resident, Department of Radiology, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania.
J Am Coll Radiol. 2022 May;19(5):597-603. doi: 10.1016/j.jacr.2022.02.031. Epub 2022 Mar 25.
To study trends in volume and reimbursement for paracentesis and thoracentesis by physicians and advanced practice providers (APPs) after the introduction of discreet Current Procedural Terminology codes for image guidance.
Medicare claims for 2012 to 2018 (paracentesis) and 2013 to 2018 (thoracentesis) were extracted using Current Procedural Terminology codes for blind and image-guided paracentesis and thoracentesis. Total volumes were analyzed by provider specialty. Nonfacility reimbursement and relative value units were compared.
For blind paracentesis, volume decreased from 17,393 to 12,226 procedures from 2012 to 2018. Conversely, volume of image-guided paracentesis increased from 171,631 to 253,834 procedures. Radiology performed the majority of image-guide paracentesis (83.9% in 2012 and 77.1% in 2018). Volume and relative share for APPs dramatically increased (from 10.2% to 15.8%). For blind thoracentesis, volume decreased from 26,716 to 15,075 procedures from 2013 to 2018. Conversely, volume of image-guided thoracentesis increased from 187,168 to 222,673 procedures. Radiology performed the majority of image-guided thoracentesis (73.6% in 2013 and 66.2% in 2018). Volume and relative share for APPs dramatically increased (from 7.7% to 12.9%). Although reimbursement for both image-guided paracentesis and thoracentesis decreased, their reimbursement remained higher than that of blind paracentesis and thoracentesis throughout the study period.
A higher percentage of these procedures are being performed using image guidance; radiologists performed a growing number but declining percentage of image-guided paracentesis and thoracentesis. APPs are playing an increasing role, particularly using image guidance. Given decreasing reimbursement for these procedures, APPs can provide a large cost advantage in procedural radiology practices.
在引入用于图像引导的离散式当前操作术语 (Current Procedural Terminology，简称 CPT) 编码后，研究医师和高级实践提供者（APP）进行的经皮穿刺术和胸腔穿刺术的数量和报销情况的变化趋势。
使用 CPT 编码，从 2012 年至 2018 年（经皮穿刺术）和 2013 年至 2018 年（胸腔穿刺术）的医疗保险索赔中提取了盲目和图像引导下的经皮穿刺术和胸腔穿刺术的数据。通过提供者专业分析总数量。比较非医疗机构报销和相对价值单位。
对于盲目经皮穿刺术，从 2012 年至 2018 年，其手术数量从 17393 例减少至 12226 例。相反，图像引导下的经皮穿刺术数量从 171631 例增加至 253834 例。放射科执行了大多数图像引导下的经皮穿刺术（2012 年为 83.9%，2018 年为 77.1%）。APP 的数量和相对份额大幅增加（从 10.2%增加到 15.8%）。对于盲目胸腔穿刺术，从 2013 年至 2018 年，其手术数量从 26716 例减少至 15075 例。相反，图像引导下的胸腔穿刺术数量从 187168 例增加至 222673 例。放射科执行了大多数图像引导下的胸腔穿刺术（2013 年为 73.6%，2018 年为 66.2%）。APP 的数量和相对份额大幅增加（从 7.7%增加到 12.9%）。尽管图像引导下的经皮穿刺术和胸腔穿刺术的报销都有所下降，但在整个研究期间，其报销仍高于盲目经皮穿刺术和胸腔穿刺术。
更多的这些手术是通过图像引导进行的；放射科医生执行的数量不断增加，但图像引导下的经皮穿刺术和胸腔穿刺术的比例却在下降。APP 发挥的作用越来越大，特别是在使用图像引导时。鉴于这些手术的报销金额下降，APP 可以在程序放射学实践中提供巨大的成本优势。
