Implications of the Revisions and Revaluation of Office/Outpatient Evaluation and Management Codes for Neuroradiology Reimbursement.

In the 2020 Final Rule, the Center for Medicare & Medicaid Services adopted a new coding structure and accepted the substantial increase in valuation for office/outpatient Evaluation and Management codes set to begin in 2021. Given budget neutrality requirements, the projected increase in reimbursement will require a reduction in the conversion factor to offset such increases. The aim is to inform neuroradiologists the impact of these proposed changes on reimbursement and the profession.

Board Certification Characteristics of Practicing Neuroradiologists.

BACKGROUND AND PURPOSE: Insight into the status of neuroradiology subspecialty certification across the United States could help to understand neuroradiologists' perceived value of subspecialty certification as well as guide efforts to optimize pathways for broader voluntary certification participation. Our aim was to assess board certification characteristics of practicing US neuroradiologists. MATERIALS AND METHODS: The American Board of Radiology public search engine was used to link Medicare-participating radiologists with American Board of Radiology diplomates. Among linked diplomates, 4670 neuroradiologists were identified on the basis of 3 criteria: current or prior neuroradiology subspecialty certification or currently >50% clinical work effort in neuroradiology based on work relative value unit-weighted national Medicare claims ("majority-practice neuroradiologists"). Subspecialty certification status was studied in each group, using Centers for Medicare & Medicaid Services data to identify additional physician characteristics. RESULTS: Of 3769 included radiologists ever subspecialty certified, 84.1% are currently subspecialty certified. Of 1777/3769 radiologists ever subspecialty-certified and with lifetime primary certificates (ie, nonmandated Maintenance of Certification), only 66.6% are currently subspecialty certified. Of 3341 included majority-practice neuroradiologists, 73.0% were ever subspecialty certified; of these, 89.1% are currently subspecialty certified. Of 3341 majority-practice neuroradiologists, the fraction currently subspecialty certified was higher for those in academic (81.3%) versus nonacademic (58.2%) practices, larger versus smaller practices (72.1% for those in ≥100 versus 36.1% for <10-member practices), US regions other than the West (64.1%-70.6% versus 56.5%), fewer years in practice (77.5% for 11-20 years versus 31.3% for >50 years), and time-limited (73.5%) versus lifetime (54.9%) primary certificates. CONCLUSIONS: More than one-quarter of majority-practice neuroradiologists never obtained neuroradiology subspecialty certification. Even when initially obtained, that certification is commonly not maintained, particularly by lifetime primary certificate diplomates and those in nonacademic and smaller practices. Further investigation is warranted to better understand neuroradiologists' decisions regarding attaining and maintaining subspecialty certification.

Current Procedural Terminology: History, Structure, and Relationship to Valuation for the Neuroradiologist.

The year 1965 was critical for US health care policy. In that year, Medicare was created as part of the Social Security Act under President Lyndon B. Johnson after several earlier attempts by Presidents Franklin Roosevelt and Harry Truman. In 1966, the American Medical Association first published a set of standard terms and descriptors to document medical procedures, known as Current Procedural Terminology, or CPT. Fifty years later, though providers have certainly heard the term "CPT code," most would benefit from an enhanced understanding of the historical basis, current structure, and relationship to valuation of Current Procedural Terminology. This article will highlight this evolution, particularly as it relates to neuroradiology.

Myelography CPT Coding Updates: Effects of 4 New Codes and Unintended Consequences.

The Current Procedural Terminology of the American Medical Association has recently introduced coding changes for myelography with the introduction of new bundled codes. The aim of this review was to help neuroradiologists understand these code changes and their unintended consequences and to discuss various scenarios in which permutations of various codes could occur in clinical practice.

The development of eye movements in the zebrafish (Danio rerio).

We investigated the development of oculomotor activity in zebrafish embryos and larvae of ages 48-96 hrs postfertilization (hpf). The optokinetic response (OKR: smooth tracking movements evoked by a rotating striped drum) improved steadily after its onset at 73 hpf, and by 96 hpf had a achieved a gain (eye velocity/drum velocity) of 0.9, comparable to adult performance. Reset movements (the fast phase of optokinetic nystagmus) developed over 75-81 hpf. The vestibuloocular reflex (VOR: compensatory eye movements evoked by passive rotation of the head) developed over 74-81 hpf, and the associated reset movements, over 76-81 hpf. The VOR was qualitatively normal in dark-reared fish, which excludes an essential role for visual experience in its early development. Spontaneous saccadic movements (the fast shift of eye position) appeared between 81 and 96 hpf, and at 96 hpf had maximum velocities that were comparable to adults. These results are compared to, and found to be incompatible with, two earlier ideas of motor development: behavioral "differentiation" and "encephalization."

The development of vision in the zebrafish (Danio rerio).

We studied the development and maturation of the visual system by determining when zebrafish begin to see and to move their eyes. This information was correlated with the time courses of the development of the retina, the retinofugal projection, the retinal image, and the extraocular muscles, to obtain an integrated picture of early visual development. Two visual behaviors were monitored over 48-96 hr postfertilization (hpf). The startle response (body twitch) was evoked by an abrupt decrease in light intensity. The optokinetic response (tracking eye movements) was evoked by rotation of a striped drum. Visually evoked startle developed over 68-79 hpf, more than 20 hr after the onset of a touch-evoked startle. It was not seen in eyeless fish, excluding a role for nonretinal light senses. Tracking eye movements developed over 73-80 hpf. They were always in the direction of drum rotation, even when the fish had been light deprived from blastula stage, ruling out a "trial and error" period of learning to track the drum. The image formed by the ocular lens was examined in intact fish made transparent by suppressing the formation of melanin. The eye was initially far sighted and gradually improved, so that by 72 hpf the image plane coincided with the photoreceptor layer. The extraocular muscles assumed their adult configuration between 66 and 72 hpf. Thus, the retinal image and functional extraocular muscles appeared nearly simultaneously with the onset of tracking eye movements and probably represent the last events in the construction of this behavior.