Assigning Objective Value to Consultative Interventional Radiology

Billing data for evaluation and management (E/M) services provided by IR from the first 3-month period of implementing a full consult and rounding service was compared to the first 3-month period of collecting E/M billing data approximately one year prior. The number and types of E/M services billed in each 3-month period were tabulated and categorized by billing under a physician or a physician assistant license. Additionally, statistics on not billed E/M by deficiency reason were also compared.

Results: The number of billed consultative and rounding E/M encounters increased from 514 prior to creation of the full consult service to 998 in the first three months after (1.94-fold increase). Additionally, the work RVU (wRVU) generated from these encounters increased 63.9% after implementation. Most of this increase was from the physician cohort that billed 310 encounters as a consult service versus 3 encounters in the reference period (103.3-fold increase; 12261% increase in wRVU). Additionally, the E/M share from low level complexity (levels 1 and 2) decreased by 12% compared to the reference 3-month period with 26.1% more moderate to high complexity E/M encounters after implementation and guidance on attestations required for billing.  The E/M encounters that could not be billed due to inadequate or missing attestations (n=372, 40%) increased after consult service creation (previously n=32, 6%). One third of the billed E/M encounters for physicians were from consultancy (20% overall physician and PA encounters), previously 0% (0.6% overall encounters). 

Conclusion:

The creation of a true consultative service is foremost an opportunity to provide better, more efficient, and more effective care. Additionally, there is a significant potential economic impact that a consultative and rounding service can offer, even when in it’s infancy.