Hoping to gain fresh insight into imaging utilization trends, researchers used the Neiman Imaging Types of Service (NITOS) coding system to study Medicare B Physician Fee Schedule billing data from 1994 to 2013, publishing their results in the American Journal of Roentgenology. NITOS, a creation the Harvey L. Neiman Health Policy Institute, provides specific details about each procedure and can be used either in conjunction with the standard Berenson Eggers Type of Service (BETOS) coding system or in its place.

In their study, the authors explained the advantages of using this newer NITOS coding system to track trends in medical imaging.

“Prior studies have used the older BETOS system established by CMS to assess trends in imaging utilization,” wrote lead author David A. Rosman, MD, MBA, department of radiology at Massachusetts General Hospital in Boston. “However, the BETOS system was designed to assign all Medicare expenditures to broad categories and was never intended to support imaging-focused studies of this nature. For example, it categorizes some invasive procedures as diagnostic imaging, thereby lowering its precision when computing rates of change for noninvasive diagnostic imaging.”

These are three key takeaways from the team’s research:

1. Of all imaging modalities, MRI and CT saw the most growth.

MRI saw a 312 percent increase in utilization from 1994 (57 per 1,000 Medicare Part B beneficiaries) to 2013 (235 per 1,000 Medicare Part B beneficiaries). CT saw a 151 percent increase in utilization in that same timeframe.

“Imaging growth over the 20-year study period was dominated by large increases in both MRI and CT,” Rosman et al. wrote.

2. Of all body regions, the brain and spine saw the most growth.

Imaging utilization increased the most for brain imaging (126 percent) and spine imaging (74 percent).

Utilization for cardiac and chest imaging went down from 1994 to 2013.

3. The NITOS coding system revealed where utilization has changed the most.

Utilization increased the most for breast MRI, cardiac CT, cardiac MRI and extremity CT. MRI exams for other body regions also saw significant growth, as one might have guessed from the previously mentioned 312 percent overall jump in utilization.

Brain radiography/fluoroscopy, chest nuclear medicine, extremity nuclear medicine and head and neck radiography/fluoroscopy saw large decreases in utilization.

More information about the NITOS coding system can be found here.