How Will DBT Be Paid For in 2015?

Written by Ronny Bachrach on November 11, 2014. Posted in Digital Radiography and PACS, DR, Hardware

Much has been said about the efficacy of digital breast tomosynthesis in the last year. The new medical imaging modality has risen to popularity given its ability to deliver comprehensive results with minimal radiation exposure for patients and technicians.

DBT visualizes the issue of tissue density and its connection to the potential development of breast cancer. A new study from the University of Sydney examined the effect that density has on radiologists' visual search patterns when conducting digital imaging procedures. Led by Dana Al Mousa, M.S.c., researchers wanted to investigate the influence that breast density has on examining doctors, HealthImaging explained.

"If we wish to optimize viewing algorithms or design appropriate training strategies, the impact of breast density on radiologists' behaviors needs to be better understood," said Al Mousa, quoted by the source.

Published in the journal Academic Radiology, the study involved seven radiologists reading a total of 149 craniocaudal digital mammograms. Seventy-five of the scans were negative for malignancies, while 74 were cancer cases. As they conducted their readings, search patterns were recorded, in addition to time to identify first lesion, dwell time and total time spent on each case.

Al Mousa and her colleagues found that for low density cases, radiologists averaged roughly 2.28 seconds to locate the first lesion in dense areas and 8.44 seconds when it was outside that region. In high density scans, it took the participating physicians an average of 7.96 seconds to identify the malignancy in dense tissue and 12.63 seconds when it was outside.

Breast density makes it difficult to accurately identify growths using digital mammography, which might contribute to the increasing utilization of DBT in today's radiology departments. But imaging providers may be hesitant to adopt the modality if they are not reimbursed properly.

Will new codes in 2015 lead to DBT payments?
According to AuntMinnie.com, the U.S. Centers for Medicare and Medicaid Services is set to finalize its ruling for 2015 that deals with digital mammography and DBT. The Medicare Physician Fee Schedule should help determine if providers will receive payments for performing these procedures on at-risk patients.

Currently, most insurance payers consider DBT to investigational and uncovered, as it is not a necessary procedure. However, as more studies reveal its advantages over traditional scans, the modality could become more commonplace.

Separate CPT codes for DBT did not exist until recently, when the Radiological Society of North America requested that several organizations, including the American Medical Association, establish new sets to address diagnostic and screening DBT.

As the final ruling draws closer, it is important for radiologists to contact their Medicare payers for coverage and billing guidance on the new codes, AuntMinnie.com explained. If an insurer does not pay for the procedures, doctors might need patients to sign an agreement that stipulates they are responsible for the financial end of the test, not the facility.

Contact Viztek for more information.

Ronny Bachrach

Ronny Bachrach

Marketing Director at Viztek LLC
Responsible for all marketing activities including, press, advertising, trade show coordination, website management, dealer and customer communications.
Ronny Bachrach
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