Wesley A. Angel MD, Presenter: Nothing to Disclose

C. Matthew Hawkins MD, Abstract Co-Author: Nothing to Disclose

Jennifer M. Wang PhD, Abstract Co-Author: Nothing to Disclose

Danny Hughes PhD, Abstract Co-Author: Nothing to Disclose

Richard Duszak MD, Abstract Co-Author: Nothing to Disclose

To evaluate national specialty trends in hepatic and renal biopsies over two decades.

Medicare Physician Supplier Procedure Summary (PSPS) master files were analyzed from 1991 to 2012 for hepatic and renal biopsies (CPT codes 47000, 50200). Procedure volumes were collected for radiologists, various specialist groups, primary care physicians, surgeons, and advanced practice providers (nurse practitioners and physician assistants). All other providers were combined. Changes and trends over time were analyzed.

Between 1991 and 2012, the frequency of liver biopsies in Medicare Part B beneficiaries increased from 25,318 to 53,055 (+110% increase) and kidney biopsies increased from 11,599 to 32,762 (+182% increase). The number of liver and kidney biopsies performed by radiologists increased from 4,277 to 46,181 (+980%) and 1,325 to 23,003 (+1636%) respectively. For most other specialties, procedure volumes declined, with the exception of nephrologists, who experienced a modest 52% increased from 1991 to 2012. Overall, the proportion of liver and kidney biopsies performed nationally by radiologists increased from 17% to 87% and from 11% to 70% respectively. Prior to 2002, advanced practice providers performed few biopsies. Since 2002, the number of liver and kidney biopsies performed by advanced practice providers has increased by 274% and 1,267% respectively.

Since 1991, the number of liver and kidney biopsies has increased and the proportion of those procedures performed by radiologists has increased dramatically. This may be due at least in part to the safety-driven movement towards image-guidance for procedures, but the economics related to declining procedural reimbursement may be contributing. Over that time, the acceptance of procedures performed by advanced practice practitioners has increased substantially.

Radiologists are now by far the largest providers of hepatic and renal biopsies on Medicare beneficiaries.

Angel, W, Hawkins, C, Wang, J, Hughes, D, Duszak, R, Liver and Kidney Biopsies: Changing Roles of Radiologists and Other Specialists from 1991 – 2012.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045422.html