Determining the Patient Complexity of Head CT Examinations: Implications for Proper Valuation of a Critical Imaging Service

• Published in: Current problems in diagnostic radiology 2020-05, Vol.49 (3), p.177-181
• Main Authors: Chen, Melissa M., Hirsch, Joshua A., Lee, Ryan K., Hughes, Danny R., Nicola, Gregory N., Rosenkrantz, Andrew B.
• Format: Article
• Language: English
• Subjects: Current Procedural Terminology; Emergency Service, Hospital - statistics & numerical data; Humans; Medicare; Neuroimaging - statistics & numerical data; Practice Patterns, Physicians' - statistics & numerical data; Retrospective Studies; Tomography, X-Ray Computed - statistics & numerical data; United States
• ISSN: 0363-0188; 1535-6302
• DOI: 10.1067/j.cpradiol.2019.05.007

The head-computed tomography (CT) exam code was recently identified by policy makers as having a potentially overvalued resource value units (RVU). A critical aspect in determining RVUs is the complexity of patients undergoing the service. This study evaluated the complexity of patients undergoing head-CT. The 2017 Medicare PSPS Master File was used to identify the most common site for performing head-CT examinations. Given the most common location, the 5% Research Identifiable File, was then used to evaluate complexity of patients undergoing head CT on the same day as an emergency department (ED) visit based on the Evaluation & Management (E&M) “level” of these visits (1-least complex to 5-most complex patient) and the ICD-10 diagnosis coding associated with the billed head CT claims. 56.1% of head CT examinations were performed in the ED. Seventy percent of noncontrast exams performed in the ED were ordered in the most complex patient encounters (level 5 E&M visits). The most common ICD-10 code for head-CT without intravenous contrast billed with a level 5 E&M visit was “dizziness and giddiness,” and for head-CT without and with intravenous contrast was “headache.” Head-CT is not only most frequently ordered in the ED, but also during the most complex ED visits, suggesting that the ICD-10 codes associated with such exams do not appropriately reflects patient complexity. The valuation process should also consider the complexity of associated billed patient encounters, as indicated by E&M visit levels.