110 - Inpatient Interventional Radiology Procedures: Cost Center or Hidden Value?

Purpose: The US healthcare system uses various payment systems for procedures and diagnoses. Compared to distinct fees associated with procedures in the outpatient setting, inpatient reimbursement utilizes a more opaque diagnosis related group (DRG) that is dependent on diagnoses, comorbidities, and procedures/surgeries performed. Given this structure, the contribution of IR to DRG reimbursement may not be readily apparent. This work aims to highlight case examples of inpatient IR services that result in meaningful changes to non-physician DRG reimbursement.

Materials and Methods: Centers for Medicare & Medicaid Services (CMS) schedules were used to calculate DRG reimbursements for three common inpatient clinical presentations. Averages were calculated with and without major complication or comorbidity (MCC), and with and without an associated IR procedure: compression fracture with or without vertebral augmentation, pulmonary embolism (PE) with or without thrombectomy, and variceal gastrointestinal (GI) hemorrhage with or without TIPS placement. Given the potential for outpatient vertebral augmentation procedures following an admission, reimbursement was calculated simulating this this scenario versus inpatient augmentation.

Results: Average DRG reimbursement for compression fractures, PE, and variceal GI bleeding was $6,523 for patients without MCC and $13,327 for patients with MCC. With the addition of vertebral augmentation, PE thrombectomy, and TIPS placement, the average DRG reimbursement was $14,836 ($8,312 increase) for patients without MCC and $35,467 ($22,140 increase) for patients with MCC. Compared to delayed outpatient vertebral augmentation, inpatient augmentation resulted in a decrease of $2,858 for patients without MCC and an increase of $4,087 for patients with MCC.

Conclusion: DRG code changes due to IR procedural management of inpatients can result in large increases in reimbursement for admission, although these financial implications may be obscured by the limited transparency of DRG payments. These findings may help interventional radiologists advocate for inpatient resources and improve inpatient access to IR services.



During the preparation of this work, the author(s) used ChatGPT 5 for spelling and grammar.