David C. Levin MD, Presenter: Consultant, HealthHelp Board of Directors, Outpatient Imaging Affiliates, LLC

Vijay Madan Rao MD, Abstract Co-Author: Nothing to Disclose

Laurence Parker PhD, Abstract Co-Author: Nothing to Disclose

Andrea J. Frangos MPH, Abstract Co-Author: Nothing to Disclose

A front page article in the New York Times of 6/17/11 reported that Medicare claims showed overuse of “double” CT scans of the thorax (i.e. CT without plus with contrast). Some hospitals were found to do these types of exams 60-90% of the time. Most radiologists agree that they should be done only on rare occasions. Our goal was to see what proportion of all thoracic CTs are done without plus with contrast in the Medicare population.

The Medicare Part B Physician/Supplier Procedure Summary Master Files for 2001, 2006, and 2011 were our data source. CPT codes 71250 (CT thorax without contrast), 71260 (CT thorax with contrast), and 71270 (CT thorax without, followed by with contrast) were selected. The files indicate procedure volume for each code in the nationwide Medicare fee-for-service population (36.3 million in 2011). The percent of scans performed without + with contrast was calculated.

In 2011 in Medicare, there were 3,316,188 thoracic CTs performed – 1,429,885 without contrast; 1,747,672 with contrast; and 138,631 without + with contrast. The latter study thus comprised 4.2% of all thoracic CTs that year. In 2006, there had been a total of 3,491,960 thoracic CTs performed, of which 212,805 were without + with contrast (6.1%). In 2001, there had been 2,016,441 thoracic CTs performed, of which 123,797 were without + with contrast (also 6.1%).

Although the New York Times article clearly identified a problem that existed in some institutions, only a small proportion (4.2%) of thoracic CT scans nationwide in 2011 were done both without and with contrast. Moreover, the proportion of thoracic CTs done that way dropped by almost one-third from 2001 and 2006 to 2011, suggesting that the practice is declining. This 4.2% figure can be used as a benchmark against which to judge radiology facilities in the future.

Not applicable.

Levin, D, Rao, V, Parker, L, Frangos, A, Are “Double” CT Scans of the Thorax Being Overused?.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13013152.html