Radiologists call for new billing codes to reward work outside of interpreting images
Radiologists are calling for the creation of consultation CPT billing codes and other solutions to compensate them for work outside of interpreting images.
Previous studies have shown that rads spend about 35% to 60% of their workhours performing such duties. These can include conducting “curbside” consultations for colleagues or attending multidisciplinary conferences to discuss cases with other medical specialties.
Yale School of Medicine radiologists sought to better understand this landscape, performing a review of research published on the topic. They shared their findings and recommendations in a new analysis published April 9 by the Journal of the American College of Radiology.
“Consultation is a prevalent, impactful, yet unreimbursed and likely underappreciated component of work in radiology,” Samra Iftikhar, MD, a researcher with Yale in New Haven, Connecticut, and co-authors concluded. “The approval of novel billing codes or the leveraging of existing mechanisms for compensating this work is expected to benefit radiology practices, health systems, as well as patients and families,” they added later. “Radiologists, with sensible incentives to do consultative work, would be able [to] better fulfill their role as the ‘doctor’s doctor.’”
Iftikhar and colleagues highlighted the sizable impact of rads’ noninterpretative work. Changes in the management of patients are seen in 8%–37% of second-opinion interpretations, 12%–55% of informal “curbside” consultations, and 8%–58% of multidisciplinary conferences. They estimated that ad-hoc and multidisciplinary consultations together constitute upward of 15% of radiologists’ regular work hours. Other less common tasks that do not produce reimbursement relate to radiation protection, risk management, direct communication with patients, staff scheduling and compliance-related meetings.
The authors suggested looking to other diagnostically oriented specialties to find solutions. Pathologists saw specific CPT codes (e.g., 80503, 80504, 80505, and 80506) introduced in 2022, which they can use for ad-hoc consultations with a single referring clinical service. The first three correspond to increasing complexity and time of consultation—5 to 20 minutes, 21 to 40 minutes, or 41-60 minutes. Each comes with incremental increases in work RVUs at 0.43, 0.91 and 1.71, respectively.
There also are CPT codes for electronic consults, including interprofessional telephone calls or assessment and management services delivered through the electronic health record.
“Such codes could theoretically provide a means of billing consultative work by radiologists, though there are practical barriers to use,” the authors noted. “Billing requires documentation of patient consent, which would likely need to be performed by the requesting physician in the case of ad-hoc radiology consultation. These codes are [generally] reimbursed at lower RVU per unit time than E&M codes (as well as pathology consultation codes), which may not provide sufficient incentive for practices to implement new workflows, unless streamlined documentation and billing mechanisms can be put in place.”
Specific codes also could be established for radiologists’ efforts related to multidisciplinary conferences. Creating such mechanisms would “fill a major gap in compensation of radiologists’ work and mitigate the current disincentives for consultative work.” However, the process of creating new CPT codes is “complex, time-consuming and requires coordination among various stakeholders.” Typically, the application and approval process can take up to two years, the authors estimated.
Another option is for radiology practices to negotiate a means of compensating noninterpretive work through hospital contracts. As one example, these tasks could be bundled and paid for via fixed stipends for individual rads. Or an organization could account for the total number of hours spent on such tasks using an “academic RVU system.”
Iftikhar and colleagues believe radiologists can make a convincing case for some of these changes. Noninterpretive work costs rads about 5 wRVUs per hour, with potential for further productivity impact among “fast” readers. Ad-hoc and multidisciplinary work likely has a monetary impact on outcomes, too.
“…It seems likely that appropriately incentivizing consultation can also be cost saving for health systems and payers in the long-term,” the authors noted. “Referral centers and academic health systems are likely to provide a relatively large proportion of consultative work and multidisciplinary care in radiology and would especially benefit from the creation or implementation of mechanisms to incentivize consultative work.”
Establishing these new payment mechanisms may become even more crucial in a future where AI use is more prevalent, and radiologists’ work focuses outside of interpretations. Cultivating more consultive work also creates more of an in-person presence for rads and grants them additional value in a world where many rads are working remotely.
“There may come a point in the future when interpretative work is made so efficient that the majority of a radiologist’s cognitive labor is focused on consultation related to complex cases, rather than primary interpretation,” the authors advised. “Our field should prioritize the creation and dissemination of mechanisms to support this critical type of work as an investment in the long-term viability of radiology as a specialty.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.