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Economic Considerations in MR Imaging of Patients with Cardiac Devices

Economic Considerations in MR Imaging of Patients with Cardiac Devices LETTERS EconomicConsiderationsinMRImagingofPatientswith CardiacDevices everal recent high-profile publications have generated interest ered alternate technique. For radiologists, accurate reporting of Sin MR imaging in patients with implantable cardiac devices, the specific device and FDA category is essential to ensure remu- some of which were traditionally considered an absolute contra- neration for covered MRI-conditional devices and to avoid fraud- indication. In particular, an analysis published in the New Eng- ulent billing for noncovered services. land Journal of Medicine documented an overall safe experience Some institutions have elected to perform these studies re- performing 1500 nonthoracic, 1.5T MRIs in patients with non- gardless of the patient’s ability to pay an out-of-pocket expense. conditional devices (1000 pacemakers and 500 implantable car- However, this may not be feasible or desirable for other facilities, dioverter-defibrillator studies) as part of a prospective registry given the time-intensive and resource-consuming processes (The MagnaSafe Registry; http://magnasafe.org/). Given the needed to screen these patients and coordinate their imaging. If a wide dissemination of this article, coupled with the estimated 1.8 self-payment is expected, this should be clearly communicated million patients with similar devices in the United States alone, and prospectively discussed with the patient, who may need to practical guidance for radiologists, who are on the front line of complete an Advance Beneficiary Notice. In certain situations, this decision-making process, is desperately needed. meeting with a hospital financial representative might help to In this setting, we wish to express our gratitude to Korutz et al minimize the impact of a large and unexpected bill following the for their recent article, “Pacemakers in MRI for the Neuroradiolo- patient’s study. gist.” Their article includes a thorough assessment of safety con- While the financial considerations entail additional logistic siderations in performing MR imaging in patients with implant- considerations in an already complex process, a proactive ap- able cardiac devices. In addition to a detailed review of the recent proach can ensure financial informed consent and may refine literature, the authors provide their own multidisciplinary proto- decisions regarding clinical work-up. col as a helpful reference for radiologists who have instituted (or are considering implementing) MR imaging in this patient pop- ulation. Furthermore, their own experience imaging 121 patients REFERENCES with nonconditional implants adds to the growing evidence that 1. Russo RJ, Costa HS, Silva PD, et al. Assessing the risks associated with MR imaging can be performed in appropriately screened and MRI in patients with a pacemaker or defibrillator. N Engl J Med 2017; carefully monitored patients. 376:755–64 CrossRef Medline 2. Nazarian S, Hansford R, Roguin A, et al. A prospective evaluation of a One additional consideration, separate from any safety issue, protocol for magnetic resonance imaging of patients with implanted must be noted. At present, the Centers for Medicare and Medicaid cardiac devices. Ann Intern Med 2011;155:415–24 CrossRef Medline does not permit coverage for routine clinical MR imaging in pa- 3. Korutz AW, Obajuluwa A, Lester MS, et al. Pacemakers in MRI for the tients with cardiac devices that are classified by the FDA as non- neuroradiologist. AJNR Am J Neuroradiol 2017 Jul 13. [Epub ahead of conditional. In fact, reimbursement is only permitted when im- print] CrossRef Medline 4. Centers for Medicare & Medicaid Services. Decision Memo for Magnetic aging is performed within the narrow scope of a prospective Resonance Imaging (MRI) (CAG-00399R2). February 24, 2011. https:// registry assessing safety. Thus, for most of these patients, the cost www.cms.gov/medicare-coverage-database/details/nca-decision- of clinically indicated MRIs will not be covered. In our experience, memo.aspx?NCAId246&bcACAAAAAAAgAAAA%3d%3d&. Ac- many providers are unaware of this crucial issue. When informed, cessed August 30, 2017 they appreciate the opportunity to discuss the implications with X M.U. Antonucci X M.V. Spampinato their patients and, when appropriate, may reconsider using a cov- X E.R. Ritenour Department of Radiology and Radiological Science Medical University of South Carolina http://dx.doi.org/10.3174/ajnr.A5450 Charleston, South Carolina E36 Letters Feb 2018 www.ajnr.org http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Economic Considerations in MR Imaging of Patients with Cardiac Devices

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Publisher
American Journal of Neuroradiology
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A5450
Publisher site
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Abstract

LETTERS EconomicConsiderationsinMRImagingofPatientswith CardiacDevices everal recent high-profile publications have generated interest ered alternate technique. For radiologists, accurate reporting of Sin MR imaging in patients with implantable cardiac devices, the specific device and FDA category is essential to ensure remu- some of which were traditionally considered an absolute contra- neration for covered MRI-conditional devices and to avoid fraud- indication. In particular, an analysis published in the New Eng- ulent billing for noncovered services. land Journal of Medicine documented an overall safe experience Some institutions have elected to perform these studies re- performing 1500 nonthoracic, 1.5T MRIs in patients with non- gardless of the patient’s ability to pay an out-of-pocket expense. conditional devices (1000 pacemakers and 500 implantable car- However, this may not be feasible or desirable for other facilities, dioverter-defibrillator studies) as part of a prospective registry given the time-intensive and resource-consuming processes (The MagnaSafe Registry; http://magnasafe.org/). Given the needed to screen these patients and coordinate their imaging. If a wide dissemination of this article, coupled with the estimated 1.8 self-payment is expected, this should be clearly communicated million patients with similar devices in the United States alone, and prospectively discussed with the patient, who may need to practical guidance for radiologists, who are on the front line of complete an Advance Beneficiary Notice. In certain situations, this decision-making process, is desperately needed. meeting with a hospital financial representative might help to In this setting, we wish to express our gratitude to Korutz et al minimize the impact of a large and unexpected bill following the for their recent article, “Pacemakers in MRI for the Neuroradiolo- patient’s study. gist.” Their article includes a thorough assessment of safety con- While the financial considerations entail additional logistic siderations in performing MR imaging in patients with implant- considerations in an already complex process, a proactive ap- able cardiac devices. In addition to a detailed review of the recent proach can ensure financial informed consent and may refine literature, the authors provide their own multidisciplinary proto- decisions regarding clinical work-up. col as a helpful reference for radiologists who have instituted (or are considering implementing) MR imaging in this patient pop- ulation. Furthermore, their own experience imaging 121 patients REFERENCES with nonconditional implants adds to the growing evidence that 1. Russo RJ, Costa HS, Silva PD, et al. Assessing the risks associated with MR imaging can be performed in appropriately screened and MRI in patients with a pacemaker or defibrillator. N Engl J Med 2017; carefully monitored patients. 376:755–64 CrossRef Medline 2. Nazarian S, Hansford R, Roguin A, et al. A prospective evaluation of a One additional consideration, separate from any safety issue, protocol for magnetic resonance imaging of patients with implanted must be noted. At present, the Centers for Medicare and Medicaid cardiac devices. Ann Intern Med 2011;155:415–24 CrossRef Medline does not permit coverage for routine clinical MR imaging in pa- 3. Korutz AW, Obajuluwa A, Lester MS, et al. Pacemakers in MRI for the tients with cardiac devices that are classified by the FDA as non- neuroradiologist. AJNR Am J Neuroradiol 2017 Jul 13. [Epub ahead of conditional. In fact, reimbursement is only permitted when im- print] CrossRef Medline 4. Centers for Medicare & Medicaid Services. Decision Memo for Magnetic aging is performed within the narrow scope of a prospective Resonance Imaging (MRI) (CAG-00399R2). February 24, 2011. https:// registry assessing safety. Thus, for most of these patients, the cost www.cms.gov/medicare-coverage-database/details/nca-decision- of clinically indicated MRIs will not be covered. In our experience, memo.aspx?NCAId246&bcACAAAAAAAgAAAA%3d%3d&. Ac- many providers are unaware of this crucial issue. When informed, cessed August 30, 2017 they appreciate the opportunity to discuss the implications with X M.U. Antonucci X M.V. Spampinato their patients and, when appropriate, may reconsider using a cov- X E.R. Ritenour Department of Radiology and Radiological Science Medical University of South Carolina http://dx.doi.org/10.3174/ajnr.A5450 Charleston, South Carolina E36 Letters Feb 2018 www.ajnr.org

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Feb 1, 2018

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