Experts find uptick in secondary imaging interpretations, low CMS denial rates from 2003 to 2016
Many believe Medicare and private payers frequently deny coverage for secondary imaging interpretations—but a team of East Coast researchers found the opposite in a study analyzing Medicare beneficiaries from 2003 to 2016.
Led by Andrew B. Rosenkrantz, MD, with NYU Langone Health’s department of radiology, the team looked at aggregate Part B fee-for-service claims frequency and payment data from the Medicare Physician/Supplier Procedure Summary Master Files for 2003 to 2016.
Their results, published July 15 in Radiology, found “broad” increases in secondary imaging service interpretations across many modalities, and “low” CMS denial rates for secondary interpretations during the study period.
Overall, in 2016, 9,738,758 secondary interpretations for radiography and fluoroscopy (R&F) were billed, compared to 568,088 for ultrasound, 84,412 for MRI and 23,120 for nuclear medicine.
Additionally, in 2016, the imaging service families with the most billed secondary interpretations were chest R&F (674,124, 75.5 percent of all billed secondary interpretations in 2016), abdominal and pelvic R&F (7.3 percent), brain CT (5.1 percent), extremity R&F (3.9 percent), abdominal and pelvic CT (1.6 percent), and chest CT (1.2 percent).Over the research period, the imaging service families with the greatest growth in this category were cardiac MRI (compounded annual growth rate of 35.7 percent), followed by breast MRI (33.1 percent) and abdominal and pelvic MRI (30.3 percent).
The secondary interpretation denial rate in 2016 was less than 25 percent for all imaging service families and below 10 percent for 19 different services.
“We believe these observations reflect referring physician and patient demand for, and payer acceptance of, secondary interpretation services at academic and other specialized medical centers, which has been described in numerous recent investigations,” wrote Rosenkranzt et al. on the low denial rates.
The authors admitted they weren’t able to “assert definitive reasons” to explain the increase in secondary interpretation volumes, but they offered a few likely contributors.
IT and data storage systems have increased capacity for uploading outside exams, which the team believes has contributed to this growth.
Additionally, they posited that health systems may be encouraging, and often requiring, secondary opinions in place of informal approaches to minimizing risks to radiologists and institutions.
Regardless of the reasons, authors believe the upward trend in second opinions is a positive step for patient management.
“Secondary interpretations have the potential to render more accurate interpretations, alter patient management and lower rates of repeat imaging examinations, which in turn may entail additional exposure to ionizing radiation and intravenous contrast agents as well as additional costs to patients and health care systems,” authors concluded.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.