The Value of Radiology Consultation: Effort Allocation, Clinical Impact, and Untapped Opportunities

Abstract

A substantial proportion of work in radiology involves activities beyond the primary interpretation of imaging. In this review, the authors discuss the current state of consultative work in radiology and evaluate potential strategies for more equitable reimbursement of these activities. “Noninterpretive” or “consultative” activities may constitute 35% to 60% of work hours. These activities routinely impact patient care; for example, changes in management are seen with 3-9% of radiologist-protocoled exams, 8-37% of secondary interpretations, 12-55% of ad-hoc (“curbside”) consultations, and 8-58% of multidisciplinary conferences. Currently, ad hoc and multidisciplinary consultations are not associated with formal mechanisms for documentation or billing, despite together constituting 10% to 15% of radiologists’ work hours. Existing and future mechanisms, however, could help bridge this gap. Practice in radiology might benefit from dedicated consultation Current Procedural Terminology billing codes, similar to those already in place for consultations in pathology. Existing non–face-to-face (electronic) consultation codes represent a potential stopgap solution. Practices may alternatively negotiate compensation for noninterpretive tasks as part of a value-based reimbursement model. Any viable solution would need to account for the opportunity cost of time spent on nonbillable activities (usually >5 work relative value units/hour). Consultation is likely to play an increasingly important role in the future of radiology with advances in imaging and artificial intelligence–based technologies. Individual radiologists and group practices would benefit from recognizing and leveraging the value of their consultative work.