Association of Interventional Radiologist Clinical Evaluation and Management Services and Procedural Complexity

Clinical evaluation and management (E&M) services performed by interventional radiologists may be undervalued by radiology practices compared with higher work relative value unit (wRVU) interventional radiology (IR) procedural services. The aim of this study was to assess whether higher E&M provision is associated with higher IR procedural complexity and the contribution of nonphysician practitioners (NPPs) in delivering IR services.

Using claims data from a 5% sample of Medicare beneficiaries (2022), the proportion of IR-related work (invasive procedures and E&M) for radiologists and NPPs was determined. Associations of E&M services and procedural complexity were assessed by each radiologist's proportion of IR-related work. In radiology-only practices, NPPs' IR-related work was assessed relative to the practice's IR focus.

A total of 30,467 radiologists met the selection criteria, collectively with 168,029 procedure and 18,051 E&M claims. Of these, 51.9% and 4.5% provided >0% and >90% IR-related work, respectively. Comparing radiologists with >0% to 10% versus >90% to 100% IR-related work, average wRVUs were 1.52 (95% confidence interval [CI], 1.50-1.54) versus 3.08 (95% CI, 3.01-3.16) per procedure and 1.42 (95% CI, 1.29-1.55) versus 1.72 (95% CI, 1.68-1.77) per E&M visit. Likewise, E&M claims per procedure were 0.01 (95% CI, 0.00-0.01) versus 0.66 (95% CI, 0.06-1.25), respectively. NPPs' IR-related work shifted from majority (84.5%) procedural at practices without IRs to majority (86.0%) E&M at majority-IR practices.

Radiologists with higher proportions of IR-related work billed more E&M claims per procedure and had higher average procedural complexity. These observed associations indicate that practice leaders should not consider the contribution of procedural and E&M services in isolation but recognize their interdependence with high-level IR practice.