Practice Management

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  • 1.  Cardiology vs Radiology practice - who should interpret vascular exams?

    Posted 06-17-2024 14:58
    Hello, 
    In the context of our professional practices, I'm interested to know if any of you have encountered a situation where a cardiology practice requests that the radiology practice not read vascular exams.
    I am curious to know how often such situations occur and whether cardiologists are typically involved in interpreting these exams. Specifically, I am referring to the following types of exams:
    1. Nuclear cardiac stress test
    2. Nuclear multigated MUGA scan
    3. CTA coronary
    4. CTA abd/pelvis runoff
    5. Lower extremity ABI ultrasound
    6. Lower extremity venous reflux/insufficiency
    7. Lower extremity arterial doppler duplex
    8. US Carotid 
    I would greatly appreciate your insights and experiences on this matter. Thank you in advance for your valuable input.


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    Valerie Basin MHA MBA
    Chief Administrative Officer (CAO) / Director Revenue Cycle Managment
    Integrated Imaging Consultants, LLC
    Skokie IL
    valerie.basin@iicmd.com
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  • 2.  RE: Cardiology vs Radiology practice - who should interpret vascular exams?

    Posted 06-17-2024 15:03

    Hi Valerie

     

    In our world, cardiac nucs and coronary CTA is normally read by the cardiologists, the latter with a radiologist over read paid for by the hospitals (who employ most of the cardiologists).

     

    We're reading vascular ultrasound and I'm not aware of any push by the cardiologists to take that on.

     

    Hope that helps.

     

    Dave

     

           David Smith, FACMPE  |  Executive Director  |  913.444.9359

    5800 Foxridge Dr.  Ste 240  |  Mission, KS  66202  |  www.uickc.com

    p-uic-horizontal-03a

     

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  • 3.  RE: Cardiology vs Radiology practice - who should interpret vascular exams?

    Posted 06-17-2024 15:24

    Hello David,

    Thank you for your response.

    This is the first time I have heard that a cardiology practice wants to take over vascular studies. I have experience when the Vascular Lab was a part of the Department of Surgery and took over the vascular studies from the radiology department. However, all the studies were interpreted by vascular surgeons. 

    Val 



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    Valerie Basin MHA MBA
    Chief Administrative Officer (CAO) / Director Revenue Cycle Managment
    Integrated Imaging Consultants, LLC
    Skokie IL
    valerie.basin@iicmd.com
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  • 4.  RE: Cardiology vs Radiology practice - who should interpret vascular exams?

    Posted 06-18-2024 07:13
    My experience is kind of the opposite of David's - most often the radiologists read and bill for the coronary CTA and then reimburse the cardiologists (or hospital) for their over-read.  The theory is that radiology is responsible for the overall operation of the department, including supervision, radiation safety, etc. and they should be the primary read on all exams.  That said, I've seen cardiac nucs go either way at various places.

    John

    John E. Pugh
    Pugh Healthcare Business Advisors
    609-644-4479





  • 5.  RE: Cardiology vs Radiology practice - who should interpret vascular exams?

    Posted 26 days ago
    Edited by Dave Stalder 26 days ago

    Valerie –

    Since CCTA is the base scan for HeartFlow's FFRct analysis, we have a unique vantage point when it comes to the intersection of radiology and cardiology CT imaging as we are working with 800+ customers nationwide. 

    To answer your question directly: we commonly see both radiologists and cardiologists over-reading different exam-types for each other. Typically, the primary reader is based upon the location of where the scan was completed. For example, if the exam is performed in a hospital (or cardiology office), the cardiologist may provide the initial interpretation with a radiologist over-reading the CT to ensure there are no incidental findings in the lungs, etc.  In the outpatient imaging setting, radiologists tend to be the the primary readers (and technical component providers if they own the imaging center) of the exams with the cardiologist as the referring physician.

    According to the most recently published Medicare data, CCTA is growing at over 20% year over year, with radiologists delivering over 60% of all CCTA interpretations (compared to all other specialists). We see continued growth of CCTA/FFRct in the outpatient setting based upon adoption of the ACC/AHA guidelines for chest pain (to avoid costly and unnecessary visits to the cath lab) and ongoing reimbursement pressure driving a shift of diagnostic testing to lower-cost settings.

    In Cook County, PFS Medicare rates are CCTA (75574) $340.82; and FFRct (75580) $926.11. There is a wide range of payments based upon Medicare location and, as always, commercial payer contracts. Hope this helps. Feel free to give me a call if you'd like to dive into this in detail.



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    Dave Stalder
    Director, Strategic & National Accounts
    Heartflow

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  • 6.  RE: Cardiology vs Radiology practice - who should interpret vascular exams?

    Posted 06-18-2024 15:01

    Hi Valerie -   We long ago lost the cardiac nucs studies.   Cardiologists are now pushing for radiologists to read the CCTA cases where ten years ago it was a shared read similar to what David said.    Vascular studies are managed thru the vascular surgeons 5-8 above.  This is Puget Sound region in Washington State.   Good luck 



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    Beth Williams MHA, FACMPE, FRBMA
    Executive Director
    Vantage Radiology and Diagnostic Services
    Federal Way WA
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