Manisha Chandrakrant Patel MD, Presenter: Nothing to Disclose

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

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

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

Diagnostic catheter angiography (DCA) has been considered the gold standard for diagnosing peripheral arterial disease (PAD), but it has been challenged by CTA and MRA, which are noninvasive and less expensive. Our purpose was to determine whether DCA has been replaced by extremity CTA and MRA in diagnosing PAD.

Nationwide Medicare Part B databases for 2002-2012 were reviewed. CPT codes for extremity MRA and CTA and supervision and interpretation of extremity DCA were selected. Physician specialty codes were used to classify providers as radiologists, cardiologists, and surgeons. Utilization rates per 100,000 Medicare beneficiaries were calculated.

Among all specialties, the combined utilization rate of all 3 types of angiography increased from 917 per 100,000 in 2002 to 1261 in 2006 (+38%), after which it remained stable until 2010, then declined to 1035 in 2012. The overall rate of MRA and CTA together rapidly increased from 89 in 2002 to 440 in 2006 (+394%), after which it leveled off, then gradually decreased to 331 in 2012. In 2012, 32% of the total procedures were MRA and CTA, up from 10% in 2002. Greater than 85% of MRA and CTA examinations were performed by radiologists. The overall rate of DCA remained stable over the course of the study. However, among radiologists, the DCA utilization rate decreased from 433 in 2002 to 120 in 2012 per 100,000 (-72%), whereas among cardiologists and surgeons together, the overall DCA utilization rate increased from 353 in 2002 to a peak of 578 in 2010 (+64%) before dropping somewhat in 2011.

Among radiologists, MRA and CTA have gradually replaced DCA, with 71% of procedures among radiologists in 2012 being MRA/CTA (29% DCA), up from 16% in 2002. While overall utilization of DCA has remained steady, it has risen sharply among cardiologists and surgeons, while dropping sharply among radiologists. The increase among cardiologists and surgeons has occurred despite availability of noninvasive alternatives. The lack of growth of MRA/CTA utilization after 2006 is likely related to multiple factors, including radiology benefits management and copay increases, and the drop in DCA among cardiologists and surgeons in 2011 is likely an apparent decrease related to bundling of invasive procedure codes.

Not applicable

Patel, M, Levin, D, Parker, L, Rao, V, Have CT and MR Angiography Replaced Catheter Angiography in Diagnosing Peripheral Arterial Disease?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045437.html