Radiologists keep control over MSK imaging turf, for now

Radiologists perform most diagnostic and minimally invasive interventional musculoskeletal studies in the U.S., with some areas experiencing continuous growth. Data released Wednesday at the RSNA meeting, however, suggest future turf battles between radiologists and surgeons are lurking on the horizon.

Dr. David C. Levin, a professor of radiology at Thomas Jefferson University, presented data comparing MSK imaging workloads for radiologists and orthopedic surgeons between 2000 and 2004. Levin and colleagues reviewed Medicare Part B data on four MSK imaging categories: plain radiography; bone densitometry, MRI, and CT.

They rated the relative value units (RVUs) for each specialty's CPT codes per 1000 Medicare beneficiaries and found that radiologists performed more than two-thirds of the overall MSK imaging studies during the five-year period. The data showed that radiologists' MSK imaging volumes grew more rapidly than those for orthopedic surgeons, who perform predominantly x-rays and densitometry reads.

The RVU rate for MRI studies allocated to orthopedic surgeons was only 5% of the radiologists' share, but the data showed this rate rising rapidly.

"The trend in MSK MR use by orthopedic surgeons may bear further watching," Levin said.

In another presentation, Dr. William Morrison, an associate professor of radiology at TJU, released a comparative study of data on biopsy procedures from the Centers for Medicare and Medicaid Services. Morrison and colleagues reviewed all claims entered between 1996 and 2003 to determine which specialties performed most MSK biopsies.

They found that, with the exception of marrow aspiration, radiologists performed most percutaneous bone biopsies. The overall rate of bone biopsies performed by radiologists during this period increased slowly but steadily. The investigators also found, however, that the rate of bone biopsies performed by surgeons - particularly orthopedic and neurosurgeons - is rapidly increasing.