QUESTION: We are finding that there is an increasing disconnect between our core privileges and our medical malpractice coverage. We are interested in some additional information regarding the experience with imaging-guided percutaneous biopsies. Our core privileges for diagnostic radiologists include imaging-guided percutaneous biopsies, but our malpractice carrier is claiming that the risk class of coverage and size of premium must be identical to that of an interventional radiologist who performs myriad diagnostic and therapeutic procedures.

I cannot recall a medical malpractice case related to an imaging-guided percutaneous biopsy procedure and can find no basis for our being placed in a category of medical malpractice coverage equal to interventional radiology, which in our environment would add an additional $15,000 to our premiums. Are you aware of any data on this issue? Related to the basic question, do all mammographers doing biopsies carry this added coverage? If so, why are breast biopsies different?

DR. BERLIN’S REPLY: In response to your query, you certainly have touched on a perplexing issue. Every malpractice insurance carrier determines its own policy with regard to how insured physicians and premiums are categorized on the basis of the nature of the physician’s practice. Here in Illinois, our main carrier has two categories for radiologists: “No minor risk procedures,” and “Minor risk procedures.” Angiography and percutaneous imaging-guided biopsy are in the latter category, and breast biopsies are in the former. As you point out, the categorization is quite odd and seems to be based more on perception than reality. Missed radiographic diagnoses of cancer on chest radiography and mammograms are the most frequent cause of medical lawsuits against radiologists and account for the highest indemnification paid to the plaintiffs. The fact is, as you already know, that complications resulting from interventional procedures are far less common and are associated with lower average indemnification payments.

So much for logic. I suggest that all you can do is try to convince your insurance underwriters that what they are doing does not make sense. Ask them to review their own claims data and see whether, indeed, lawsuits emanating from biopsies have been frequent and expensive. I doubt they will find evidence to support their current policy, but whether it would be enough to convince them to revise the policy remains to be seen.

The Physician Insurers Association of America (PIAA), located outside of Washington, DC, collects medical malpractice data from a number of carriers in the United States. You may be able to get some data from the PIAA Website that could assist you in arguing your cause with your carrier.