In an effort to maintain the standard of care established by the American College of Radiology (ACR), the Joint Commission and others, the Centers for Medicare and Medicaid Services (CMS) requires you to ensure that your CT scans meet all four attributes of the MITA Smart Dose CT as set by the National Electrical Manufacturers Association (NEMA) XR 29-2013.
What is NEMA XR-29-2013?
The NEMA Standard XR-29, also known as the MITA Smart Dose Standard, includes DICOM-compliant radiation dose structured reporting, dose check features, automatic exposure control and reference adult and pediatric protocols.
The attributes of MITA Smart Dose CT Include
- DICOM Dose Structured Reporting. This enables recording of post-exam dose information in a standardized electronic format. This information can be included in the patient record, promoting the establishment of diagnostic reference levels, as well as facility dose management and quality assurance.
- Pediatric and adult reference protocols. A set of pre-loaded protocols on a CT system that serve as a baseline for a variety of clinical tasks.
- CT Dose Check. This incorporates two features, dose notifications and dose alerts, which can alert operators and physicians when the dose exceeds established thresholds.
- Automatic Exposure Control (AEC).. This automatically adjusts the amount of radiation used based on the size, shape and composition of the patient in order to achieve a specified level of image quality. Studies of AEC procedures have demonstrated dose optimizations and reductions when used properly.
- DICOM Dose Structured Reporting. This enables recording of post-exam dose information in a standardized electronic format. This information can be included in the patient record, promoting the establishment of diagnostic reference levels, as well as facility dose management and quality assurance.
- Pediatric and adult reference protocols. A set of pre-loaded protocols on a CT system that serve as a baseline for a variety of clinical tasks.
- CT Dose Check. This incorporates two features, dose notifications and dose alerts, which can alert operators and physicians when the dose exceeds established thresholds.
- Automatic Exposure Control (AEC).. This automatically adjusts the amount of radiation used based on the size, shape and composition of the patient in order to achieve a specified level of image quality. Studies of AEC procedures have demonstrated dose optimizations and reductions when used properly.
The law signed in April 2014 will begin affecting diagnostic imaging providers on January 1, 2016. At that time, Medicare will reimburse CT scans that do not meet all four attributes at a lower rate. Equipment that is not in compliance will be subject to a five percent/per scan technical component reduction on diagnostic CT procedures billed in physician office and hospital outpatient settings. The reduction will increase to 15 percent on January 1, 2017.
If you bill for both inpatient and outpatient CT scans on the same scanner, the reduction only applies to scans billed as outpatient procedures. The MITA Smart Dose policy does not affect scans billed under the hospital inpatient setting or for interventional radiology procedures.
As a provider, you will be required to report when a CT service is performed using equipment that is not compliant with the Smart Dose Standard. At a minimum, you will need to provide documentation from the manufacturer of your CT system stating that your system does or does not meet the four attributes.
The ACR has additional, in-depth information about the new rules. MITA also published a helpful white paper about what you need to know and do to make sure you are compliant.
Use Vendors Wisely to Ensure Compliance
It’s best to contact your equipment manufacturer for more information on whether your machine complies with the MITA Smart Dose Standard or to find out more information on bringing your CT equipment into compliance with this new standard. Appendix A of the white paper offers guidance on selecting vendors in the event you need to modify or upgrade your CT system.
MITA suggests using caution when selecting a vendor. For example, a reputable vendor will provide certification that the four attributes have been integrated on new equipment or upgrades to existing equipment. Be sure you clearly understand what you are buying and how any upgrades might affect the original equipment manufacturer’s warranty.
Also be careful not to under- or overbuy. You only need to modify your existing equipment or purchase just enough to be compliant. In Appendix A of its white paper, MITA emphasizes, “Smart Dose Standard compliance requires these four, and only these four, attributes. There are no substitutes (e.g., iterative reconstruction) for any one or all of them that can make your equipment compliant or render any one or more of these four attributes unnecessary.”
Don’t Wait | Smart Radiology Dose Standards
While 2016 still seems far off, in reality, it’s only a few months away. As a result, now is the time to ensure that you are compliant so you aren’t penalized or lose any reimbursements.
Smart Radiology Dose Standards Sources
http://www.medicalimaging.org/policy-and-positions/mita-smart-dose/.