David C. Levin MD, Abstract Co-Author: Consultant, HealthHelp, LLC Board of Directors, Outpatient Imaging Affiliates, LLC

Bhavik Patel MD, Presenter: Nothing to Disclose

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

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

In 2010, the CPT codes for MPI, LV wall motion, and LV ejection fraction were bundled together into a single new code that sharply reduced reimbursement. Other policy decisions in recent years have also adversely affected reimbursement. As a result, many cardiology office practices migrated into hospital employment. Our purpose was to see if this led to a noticeable shift in place-of-service of these exams from offices to hospital outpatient departments (HOPDs). This would lead to higher costs, since outpatient imaging reimbursements to hospitals are considerably higher than those to offices.

The nationwide Medicare Part B databases for 2002 to 2012 were the data sources. The primary CPT codes for MPI were selected and utilization rates per 1000 beneficiaries were calculated for outpatients. Medicare’s place-of-service codes were used to identify elective outpatient studies done either in private offices or HOPDs. Specialty codes identified those exams done by radiologists (including nuclear medicine physicians), cardiologists, and other physicians. Trends were analyzed over the study period.

The private office MPI utilization rate per 1000 rose from 37.8 in 2002 to a peak of 57.3 in 2008 (+52%). It dropped slightly in 2009, then began a steady and steeper decline, dropping to 35.0 in 2012 (-39% vs peak). In HOPDs, the rate dropped somewhat from 18.8 in 2002 to 15.6 in 2008 and 2009 (-17%), but then increased to 20.6 in 2012 (+32% vs nadir). Most outpatient MPI scans are done by cardiologists and their utilization trends generally mirrored the trends for total MPIs by all specialists as a group. On the other hand, radiologists’ use of MPI has declined steadily in both venues in recent years.

In recent years, outpatient MPI use has declined sharply in offices. This is likely due to lower reimbursement – principally resulting from code bundling - which has led many cardiologists to close their offices and become hospital employees. At the same time, MPI use in HOPDs has begun to increase. This shift is an unfavorable result of code bundling. Costs will rise because Medicare pays HOPDs more than it does private offices for the scans. In addition, the role of radiologists and nuclear medicine physicians has been diminished.

not applicable

Levin, D, Patel, B, Parker, L, Rao, V, The Redirection of Outpatient Radionuclide Myocardial Perfusion Imaging (MPI) from Offices to Hospital Facilities as a Result of Code Bundling – Cost Implications.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003560.html