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CT Abdomen and Pelvis: A Case Study in Devaluation

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Introduction

CT of the abdomen and pelvis (A/P) when performed together will now be reported with a single code rather than two separate codes. The creation of the combined CT A/P code has led to immediate decreases in professional, technical, and hospital payments compared with the sum of the payment for the individual codes.

In this column, I take the reader through a case study demonstrating how a service as valuable as CT A/P could be subjected to such across-the-board cuts, addressing questions that may be on radiologists' minds. For each question, I provide a brief background, describe the ACR's actions, and then describe the result. I also briefly discuss the broader effects of this bundling trend.

Section snippets

Background

CMS remains focused on identifying “potentially misvalued services,” which it identifies through a number of code “screens” [1]. Once identified, these individual codes are often reevaluated using the process by which codes are created and valued. In other words, old codes are turned into new ones. One of the CMS code screens captured the combination of CT A/P, and an action plan was requested.

What We Did

The ACR asserted that creating a new code combination could have unexpected and undesired

Background

Any specialty may contribute to writing new codes; however, the dominant provider of the service is expected to take the lead. Diagnostic radiology, the most common provider of CT services, was charged with generating a workable code structure and given a fairly limited time frame in which to accomplish this.

What We Did

The ACR's Coding and Nomenclature Committee drafted and presented the current three-code structure, which was subsequently accepted. Consideration was given to ensuring that all potential

Background

When abdominal and pelvic CT were bundled, the combined service was treated the same as any new service for the purposes of valuation. For that reason, the existing values for the individual codes were not simply added. Rather, a new valuation was required.

What We Did

The ACR led the effort to value the new codes through the established mechanism of surveying our members. Our survey results actually supported that the work value of the combined codes equaled the sum of the value of the individual codes.

Background

CMS determines technical component (TC) payments for all services using a complicated methodology that is influenced by survey data obtained from physicians, the Physician Practice Information Survey (PPIS). These survey data were recently updated and beginning in 2010 applied to radiologic services. The data resulted in significant reductions in TC payments.

What We Did

Since the new data were first introduced, the ACR has asserted that the data do not sufficiently capture office-based radiology costs. CMS

Background

Payment to hospitals for outpatient radiology services is based on a system whereby services are assigned to groups called ambulatory payment classifications (APCs). Services within the same APC are similar clinically and in terms of the resources they require. For CT, there are APCs for instances in which only a single CT scan is provided and different APCs, called composite APCs, for instances in which multiple CT studies are performed. As expected, payment is greater for composite APCs than

What Does All of This Mean to Me?

CMS seems intent on reducing payment for all non–primary care physician services, and radiology has certainly endured its share of these cuts. Additional radiology services, including several interventional radiology services, will likely fall victim to CMS's screens and be sent back through the code creation and valuation process. The result could be reductions in professional component, TC, and hospital payment similar to those experienced for CT A/P.

This case study demonstrates that even the

References (2)

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