ACR Bulletin July 2018

What Is the QQ Modifier?

Here’s a look at the new clinical decision support mechanism modifier.

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The Protecting Access to Medicare Act (PAMA) of 2014, Section 218(b), established a new program under which an ordering provider of advanced diagnostic imaging studies must consult a clinical decision support (CDS) mechanism at the time of ordering. The program is slated to begin on July 1, 2018. This date is the start of a voluntary participation and reporting period using a new Healthcare Common Procedure Coding Sys­tem modifier, “QQ.” This column describes how billing claims will occur during this voluntary reporting period and provides background on the broader move toward full CDS implementation.

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July 2018 Case of the Month

Arterial-enteric fistula

Access case here.


Patrick Hussey, MD, MS
PGY-5, Radiology Resident,
Department of Radiology
MetroHealth Medical Center
Cleveland, OH

Ignacio Chiong, MD
Assistant Professor of Radiology,
Interventional Radiology,
Department of Radiology
MetroHealth Medical Center
Cleveland, OH

Danesh Bansal, MD, MPH
PGY-3, Radiology Resident
Department of Radiology
The MetroHealth System/Case Western Reserve University
Cleveland, OH

Ahead of the Curve

Early adopters of CDS deliver more appropriate imaging and help ordering physicians prepare for PAMA’s impact on reimbursement.

When the radiology team at Einstein Healthcare Network in Philadelphia first heard about the Protecting Access to Medicare Act (PAMA) of 2014, which requires providers to consult clinical decision support (CDS) for advanced image ordering, they had an uncommon response: Bring it on!

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Crossing the Line

The national conversation around sexual harassment comes to radiology.crossing the line

Sexual harassment is not a new problem, nor is it unique to med­icine. The issue has garnered unprecedented attention, however, from efforts like #MeToo — exploding on social media last year to raise awareness of sexual harassment and assault in the workplace. “Movements like this have opened the door now for men and women to say, ‘This isn’t right,’” says Claire E. Bender, MD, MPH, FACR, chair of the ACR Commission on Human Resources and professor emerita in the department of radiology at the Mayo Clinic in Roches­ter, Minn.

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Easing the Burden

We’re all searching for strategies to thrive in a demanding environment.

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As physicians, we go to work every day to provide high-quality and safe care for our patients. But what about our own health and well-being? Are you feeling exhausted, depersonalized, or unengaged? Could you be burned out? Unfortunately, you wouldn’t be the only one.

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Final Read

Monica J. Wood, MDfinal read

Q: What advances in the field of radiology do you find most exciting?

One of the most exciting developments within radiology is the introduction of machine learning, which has the potential to augment our diagnostic and opera­tional capabilities. Just as the transition from film to PACS revolutionized radiology and brought about unprecedented gains in efficiency, thoughtful and targeted machine learning applications will have a similar impact on our ability to deliver high-quality care. Embracing these algorithms will help us process an increasing amount of information to distill what is clinically relevant. The automation of mundane and repetitive tasks will give us more time to engage directly with referring clinicians and patients — increasing the value of imaging, improving the patient experience, and boosting physician satisfaction.

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Radiologists to the Rescue

ACR members join forces to lead relief efforts for post-hurricane Puerto the rescue

In September 2017, Hurricane Maria struck Puerto Rico. With sustained winds of 155 mph, the Category 4 storm uprooted trees, razed homes, and caused widespread, catastrophic flooding. The disaster killed more than 4,600 people, and millions were left without electricity, water, or cell phone service.1 Members of the Radiological Society of Puerto Rico in San Juan immedi­ately sprang into action to assist in the recovery efforts.

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Step Into the Future of Medical Imaging

AI and informatics in radiology will take center stage at the ACR Annual Conference on Quality and Safety.step into the future

The future of medical imaging — and the ability to adapt to new quality metrics, clinical decision support, and enhanced patient care — will guide the conversation at the 2018 ACR Conference on Quality and Safety. Top quality and data science experts will convene to share the latest tools and insights on how AI can be used to optimize business efficiencies and high-level patient care.

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Taking Steps to Improve Well-Being

New radiology-specific research finds musculoskeletal strain is widespread, but minor adjustments can make a big difference.improve well being

We’ve all seen the dramatic headlines: “Sitting Is the New Smoking!” “Sitting is Killing You!” And, indeed, sedentary lifestyles have been shown to compromise cardiac and metabolic health, as well as negatively impact quality of life. Prolonged sedentary time is also associated with increased rates of burnout and fatigue and decreased ability to concentrate. Radiologists are at an increased risk of being sedentary at work com­pared with other medical specialties. This risk has been magnified in recent years with an increasing volume of cases, pressure for fast reporting, and emphasis on relative value units.1 The current digital environment and PACS workstations have also contributed to the development of musculoskeletal injuries in radiologists. Long hours sitting at workstations and failure to take breaks likely contribute to low back pain, neck pain, and repetitive stress injuries in radiologists.2

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