Radiologists rapidly launch inpatient IR consult service that’s generating tens of thousands in new revenue

Radiologists are detailing their experience launching an inpatient interventional consult service that is generating tens of thousands in new revenue.

Four members of the specialty quickly established and maintained the service line during a 27-month period at the Arkansas Children’s Hospital in Little Rock. Annual consultation volumes have since trended upward, as have payment collections, “resulting in previously uncaptured IR service revenue,” experts wrote May 8 in Pediatric Radiology [1].

“In the past two decades, the Society of Interventional Radiology and the American College of Radiology have encouraged an expansion of clinical practice for IR and DR. This call to action is founded on the idea that radiology groups offering diagnostic and consult services are more valuable to patients and other providers,” wrote pediatric radiologist Charles A. James, MD, and colleagues. “Literature suggests many IR physicians have been moved to this call to action.”

For the University of Arkansas for Medical Sciences, that response started with the launch of the IR consult service in October 2019. A pediatric IR section leader worked with vendor Epic to help create new consult note templates integrated into the electronic health record. Charges for such services were generated automatically in the EHR based on differing levels of evaluation and management services tied to inpatient consult codes, experts noted. The retrospective study spanned from October 2019 to January 2022 at the single, 336-bed academic children’s hospital.

During that span, interventional radiologists performed a total of 2,153 inpatient consults spanning 1,757 hospital encounters logged in the EHR. The children’s hospital saw monthly consults peak about five months into the study period. Corresponding author James and colleagues gave the following breakdown of the most-used current procedural terminology codes:

• Level 1: CPT 99251, focused (20 minutes): 8.7% of consultations during the study period.  
• Level 2: CPT 99252, expanded (40 min): 81.7% of consults.
• Level 3: CPT 99253, detailed, low (55 min): 8.8%.
• Level 4: CPT 99254, complicated, moderate (80 min): 0.7%.

About 69.7% of these instances had “consult-specific billing” with payments in 96.4%, resulting in $143,976 in new revenue during the study period. And between 2020-2021 (and amid the pandemic), IR consult volumes actually trended upward by 13.4%, while consult-specific payments leapt by 84.1%, the authors noted. They also logged an IR consult procedure conversion rate of 96.5%.

James and co-authors estimate that the new service added a median of a dozen additional minutes per IR consult to physicians’ workloads.

“While 12 min can add up to a significant amount of time within a busy week, the value of documented specialized IR input in the medical record and additional revenue brought in by the consult itself justifies the time spent,” the study noted. “The authors realize physician burnout can result with added work effort; however, burnout for radiologists often comes from the pressure to meet RVU requirements, social isolation, and the moral injury of feeling like a technician rather than a fellow physician colleague. This latter burnout factor can partially be relieved by doing clinical assessments and providing the patient with specialized IR care.”

Read much more about the project in Pediatric Radiology below.