CHICAGO - By all accounts, MR spine imaging has supplanted the use of myelography by neuroradiologists. In fact, there was an 83% rise in the use of MR for spine imaging in the Medicare population between 1993 and 1999. However, according to a group of researchers from Thomas Jefferson University Hospital in Philadelphia, billing for myelography almost doubled during the same period of time.
"What we wanted to know, since the use of myelography by radiologists has been in steady decline for the past decade, is who is billing for performing this procedure?" said Dr. Vijay Rao, the research team’s presenter at the RSNA.
Rao and her colleagues examined the 1993 and 1999 nationwide Medicare Part B databases to see if they could identify the culprits. The CPT code for myelography injection, 62284, and the myelography supervision and interpretation (S&I) codes (72240-72270) were tallied for the time period in question.
The group also determined the specialty of the providing physicians from the databases, on the basis of the physician’s self-reported specialty code. This allowed the team to categorize the physicians as diagnostic radiologist, neurosurgeon, anesthesiologist, and others (such as orthopedic surgeons).
Rao noted that approximately 5.5% of the total could not be categorized as they came from multi-specialty practices. For purposes of the study, they were excluded from the results.
For CPT code 62284, of the total 88,404 claims submitted in 1993, radiologists, neurosurgeons, and anesthesiologists were responsible for 61%, 22%, and 4%, respectively. For the same code a total of 128,402 claims were submitted in 1999, with claims by radiologists and neurosurgeons dropping to 40% and 9%, respectively. However, the claims submitted by anesthesiologists rose to 39.2% of the total, a 1,296% increase in usage over the six-year period.
For the S&I codes 72240-72270, of the total 101,666 claims submitted in 1993, radiologists, neurosurgeons, and anesthesiologists were responsible for 92%, 1.7%, and 1.5%, respectively. For the same code, of the total 112,236 claims submitted in 1999, claims by radiologists and neurosurgeons dropped to 60% and 0.6%, respectively.
The claims submitted by anesthesiologists increased 24% of the total, a 1,619% increase.
Although myelography performed by radiologists decreased more than 20% during the study years, there was a 45% increase in myelography of the Medicare population over the same period. Meanwhile, anesthesiologists’ use of these billing codes grew at a 14- to 16-fold rate.
"We know who is billing for this procedure, but we don’t know why," said Rao. "I believe they’re using this code for something other than myelography," she noted.
By Jonathan S. Batchelor
AuntMinnie.com staff writer
November 29, 2001
For the rest of our coverage of the 2001 RSNA meeting, go to our RADCast@RSNA 2001.
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