Clinical services by interventional radiologists: perspectives from Medicare claims over 15 years.

Objective: The aim of this study was to assess 15-year trends in nonprocedural clinical evaluation and management (E&M) services provided by interventional radiologists (IRs).

Methods: Medicare Physician Supplier Procedure Summary data from 1993 through 2008 were analyzed for changes in fee-for-service Medicare claims for nonprocedural clinical encounters (eg, consultations, rounds) provided by IRs. Current Procedural Terminology® E&M code 99201 to 99499 claims were extracted for IRs and analyzed for trends in volume, complexity, site of service, and payment denials.

Results: Between 1993 and 2008, IRs' claims for E&M services increased by 1,200% (from 4,210 to 54,726), with increases in low-complexity (+1,384%, from 1,595 to 23,671), medium-complexity (+1,407%, from 1,386 to 20,884), and high-complexity (+728%, from 1,229 to 10,171) encounters. Volume increases were largest in the physician office setting (+2,298%, from 995 to 23,856) but also present in the inpatient (+1,112%, from 1,550 to 18,781), outpatient hospital (+492%, from 1,636 to 9,677), and miscellaneous (+8,217%, from 29 to 2,412) settings. Between 1993 and 2008, payment denial rates for IRs' E&M services declined from 22% to 11% (from 906 of 4,210 to 6,050 of 54,726, P <.001).

Conclusions: Interventional radiologist claims for nonprocedural clinical encounters with Medicare fee-for-service beneficiaries increased 12-fold over the 15 years from 1993 to 2008, as payment denial rates dropped by half. Evaluation and management services by IRs have grown fastest in the private office setting, which now represents the single most common location of these services.