Determining the Patient Complexity of Head CT Examinations: Implications for Proper Valuation of a Critical Imaging Service
Publication date: Available online 10 May 2019
Source: Current Problems in Diagnostic Radiology
Author(s): Melissa M. Chen, Joshua A. Hirsch, Ryan K. Lee, Danny R. Hughes, Gregory N. Nicola, Andrew B. Rosenkrantz

Abstract

Purpose

The head-CT exam code was recently identified by policy makers as having a potentially overvalued 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.

Methods

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 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.

Results

56.1% of head CT examinations were performed in the ED. 70% of non-contrast 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 IV contrast billed with a level 5 E&M visit was “dizziness and giddiness”, and for head-CT without and with IV contrast was “headache”.

Conclusion

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 reflect patient complexity. The valuation process should also consider the complexity of associated billed patient encounters, as indicated by E&M visit levels.