title: Musculoskeletal biopsy: utilization and provider distribution in the United States Medicare population.
abstract: OBJECTIVE
  Physicians from many specialties perform musculoskeletal biopsy. Using the Medicare database, we sought to determine which specialties represent the physicians who are performing the majority.
  
  
  METHODS
  Using the CMS physician supplier procedure summary master file for 1996-2003, we extracted all claims for biopsy procedure codes (including marrow aspiration, muscle biopsy, percutaneous bone biopsy, and open surgical biopsy) categorized by provider specialty, and we analyzed procedure volumes.
  
  
  RESULTS
  Since 1996, the rate of utilization of percutaneous bone biopsy has remained stable. In 2003, marrow aspiration was most commonly performed by hematology/oncology (80,038, 57%), followed by medical oncology (23,428, 17%); radiologists performed 755 (0.5%). Muscle biopsies were predominantly performed by radiologists (4,761, 40%), followed by neurosurgery (591, 5%). Percutaneous bone biopsy was mostly performed by radiologists (14,830, 53%), but orthopedic surgeons, neurosurgeons, and hematology/oncology specialists performed a large minority (6,879, 2,296, and 1,048 respectively; in aggregate, 37%). From 1996 to 2003, radiologists performed 71% more muscle biopsies (2,788 to 4,761) and 60% more percutaneous bone biopsies (9,259 to 14,830). Although most specialties are performing fewer percutaneous bone biopsies (e.g., oncologists: 7,217 to 1,048, -85%), orthopedic surgeons are performing 247% more (1,983 to 6,879) and neurosurgeons are performing 2,343% more (94 to 2,296).
  
  
  CONCLUSIONS
  Excluding marrow aspiration, radiologists perform the majority of percutaneous bone biopsies, and the volume is increasing in the U.S. Medicare population. The overall volume has remained relatively stable from 1996 to 2003; although medical specialties are performing fewer, the volume performed by surgeons is increasing rapidly.
authors.affiliation: Department of Radiology, UPMC, Pittsburgh, PA, USA. eoinkav@yahoo.com
authors.forename: Eoin C
authors.initials: EC
authors.lastname: Kavanagh
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Roberts
authors.forename: Andrea
authors.initials: A
authors.lastname: Frangos
authors.forename: Laurence
authors.initials: L
authors.lastname: Parker
authors.forename: Angela
authors.initials: A
authors.lastname: Gopez
authors.forename: Diane
authors.initials: D
authors.lastname: Deely
authors.forename: William B
authors.initials: WB
authors.lastname: Morrison
mesh_terms: D001706:Biopsy / Q000706:statistics & numerical data*; D016208:Databases, Factual; D013502:General Surgery; D006801:Humans; D006278:Medicare; D009141:Musculoskeletal System / Q000473:pathology*; D011871:Radiology; D014481:United States