Few Do Most: National Patterns of Cognitive-to-Procedural Share Among U.S. IR Physicians

To quantify evaluation and management (E&M) billing patterns among U.S. interventional radiologists (IRs).

A cross-sectional analysis was performed using a 100% sample of 2023 Medicare fee-for-service claims. IRs were stratified into three mutually exclusive IR-related workload tiers by wRVU (10-49%, 50-89%, ≥90%). Multivariable negative-binomial regression adjusted for total wRVUs and physician/practice characteristics.

Among 5,232 IRs, E&M billing increased disproportionately with IR-related workload. Across increasing IR-related workload, surgical-procedure RVUs increased 4.2-fold, whereas E&M RVUs increased 23.9-fold. Only 23.5% of IRs billed ≥11 E&M claims. After adjustment for total wRVUs, IRs in the 10-49% and 50-89% workload tiers billed 90% fewer E&M encounters (aRRR 0.10, 0.10-0.11) and 28% fewer (aRRR 0.72, 0.66-0.79), respectively, than IRs in the ≥90% tier. Among IRs billing ≥11 E&M claims, tier-based differences attenuated, with the 50-89% tier approaching parity with the ≥90% tier (aRRR 0.89, 0.78-1.003). Female sex was associated with fewer E&M claims overall (aRRR 0.82, 0.75-0.89), but more in the ≥11-claim subset (aRRR 1.25, 1.03-1.52).

E&M billing among U.S. IRs is concentrated among a minority of physicians and increases disproportionately with IR-related workload. Attenuation of workload-tier differences among IRs billing ≥11 E&M claims suggests observable E&M engagement reflects a distinct clinical practice model rather than a simple function of procedural volume. Structural factors, including sex, may influence participation in observable E&M billing.