Volumes of secondary diagnostic image interpretations among Medicare beneficiaries are on the rise, according to a new study conducted by researchers at the Harvey L. Neiman Health Policy Institute.

Secondary interpretation exams rose by a compound annual growth rate of more than 20 percent between 2003 and 2016 for service families, while interpretation denial rates were below 25 percent in 2016.

“The secondary interpretations often occur at referral centers, where a more subspecialized level of interpretation may be available,” Dr. Andrew Rosenkrantz, professor and director of health policy in the department of radiology at NYU Langone Health and a Neiman Institute affiliate research fellow, told HCB News. “The growth in secondary imaging interpretation volumes may reflect ongoing trends toward a higher degree of subspecialization that is available in certain settings for diagnostic and therapeutic purposes.”
Researchers calculated and compared billed and denied service volumes across modality and body region service families using aggregate Part B fee-for-service claims frequency and payment data, acquired from Medicare Physician/Supplier Procedure Summary Master files.

Focusing on seven service families, the authors found that billed secondary image interpretation services for select high-volume service families exceeded primary interpretations for exams such as chest radiography and fluoroscopy (R&F), brain MR, and abdominal and pelvic CT.

Chest R&F, brain CT, extremity R&F, abdominal and pelvic CT, and chest CT were the most billed secondary interpretations among body region and modality service families.

Denial rates for secondary interpretation services are uniformly low, with many imaging service families incurring less than 10 percent.

Such rates, according to Rosenkrantz, are comparable to previously reported denial statistics for primary interpretations, and indicate increasing demand among clinicians and greater acceptance by payors of these services for the value they provide.

He warns, however, that the study is limited in the fact that it is only based on aggregate national claims data and does not assess secondary interpretations at individual examination levels, making it unsuitable alone in determining an accurate comparison of primary and secondary interpretations.

“Specific conclusions cannot be made using our data regarding the accuracy of primary vs. secondary interpretations,” he said. “Nonetheless, the drastic growth in utilization nationally of secondary interpretations suggests that managing physicians find such secondary interpretations to be valuable. While not directly addressed by the current study at hand, a separate meta-analysis by our research group does, in fact, suggest that there may be a higher level of accuracy by secondary interpretations.”

The findings were published in the Journal of the American College of Radiology (JACR).

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