Cath Lab Digest - March 2008 - (Page 76)

76 ACVP MANAGEMENT CORNER MARCH 2008 CMS 2008 OPPS Final Rule Review John Rader, Jennifer Williams, Susan Heilman Healthcare Economics, Medtronic, Inc. Minneapolis, Minnesota Table 1. Services that require a modifier (FB or FC) AICD, Single chamber (C1722) AICD, dual chamber (C1721) Lead, coronary, venous (C1900) Pacemaker, single, rate responsive (C1786) Pacemaker, single, non rate responsive (C2620) Pacemaker, dual, rate responsive (C1785) Pacemaker, dual, non rate responsive (C2619) Pacemaker, other than single or dual (C2621) Lead, AICD, endo single coil (C1777) AICD, other than single or dual (C1882) Event recorder, cardiac (C1764) Lead, pacemaker, transvenous VDD (C1779) Lead, pacemaker, other than transvenous (C1898) Lead, pacemaker, pacemaker/ICD combination (C1899) Lead, AICD, non single/dual (C1896) A s the range of today’s cardiovascular procedures continues to expand and their sites of service shift, familiarity with coding and reimbursement changes is critically important to assure compliance with CMS’s regulations and appropriate integrity of the hospital’s revenue cycle process. On November 1st, CMS released the Outpatient Prospective Payment System (OPPS) Final Rule, which is effective for services provided on or after January 1, 2008. This overview will provide an update regarding the pertinent changes for services delivered in the cath lab, electrophysiology (EP) lab and peripheral vascular labs. The 2008 Final Rule includes significant policy, coding and payment changes that are important for everyone to understand. Highlights of the 2008 Final Rule include: • CMS projects 2008 OPPS payments to hospitals will increase by about 10% to approximately $36 billion, due in part to increased utilization. • An increase in the APC Conversion Factor to $63.694. • Elimination of ICD generator GCodes beginning January 1, 2008. Hospitals will need to report CPT 33240 or 33249, as the G codes will no longer be • • • • valid for reporting purposes. Creation of a composite (i.e. blended) Ambulatory Payment Classification (APC) to cover payment for EP studies and catheter ablations performed in the same visit. Creation of a new modifier, FC, for a partial device credit. This builds on the FB modifier that was created for no-cost devices in 2007. The Medicare Part A deductible was increased to $1,024 and represents the annual maximum patient co-payment amount for hospital outpatient services. Packaging of supportive ancillary services, including imaging supervision and interpretation, for noncoronary vascular procedures. Lead, AICD, endo dual coil (C1895) Key Coding and Reimbursement Changes Effective January 1, 2008 Arrhythmia Procedures • When EP studies (CPT codes 93619, 93620) and catheter ablations (CPT 93650, 93651, 93652) are provided in separate encounters, Medicare will reimburse the applicable APC (APC 0085 or APC 0086). • APC 0087 was deleted and selected EP services were reclassified from APC 0087 to APC 0084. This list includes: Bundle of His, intra-atrial, and right ventricular recordings (CPT 93600, 93602, and 93603 respectively); as well as intra-atrial, right ventricular pacing (CPT 93610, 93612), esophageal recordings of atrial electrograms (CPT 93615, 93616), and induction of arrhythmia by electrical pacing (93618). • AV Node ablation (CPT code 93650) was reclassified from APC 0086 to APC 0085. • SVT and VT Ablations (CPT codes 93651 and 93652) remain in APC 0086. • The G-Codes that were assigned to ICD generator and ICD system implants have been eliminated and replaced: - G0300 and G0299 have been replaced with CPT 33249 (insert ICD system) - G0298 and G0297 have been replaced with CPT 33240 (insert ICD generator) • CMS created a Composite APC that provides a single payment for all clinically-related services provided within an encounter or episode of care. APC 8000 includes the performance of a cardiac electrophysiologic evaluation (CPT 93619 or 93620) and a catheter ablation (CPT 93650, 93651 or 93652). • The Fluoroscopy CPT code 71090, has changed to a status indicator N, meaning that the payment is packaged into the APC rate for other services. Therefore, a separate APC payment is no longer available for this fluoroscopy service. Coronary Vascular Procedures • Payments for coronary angioplasties and atherectomies are now combined with non-coronary procedures. Payment adjustments reflect the merging of coronary and non-coronary procedures into APCs 0082 and 0083. • The intravascular IVUS CPT codes 92978 and 92979 have been changed to a status indicator N, meaning that the payment is packaged into the APC rate for other services. Therefore, a separate APC payment is no longer available for these IVUS codes. Peripheral Vascular Procedures • The intravascular IVUS CPT codes 37250, 37251 and 75946, have been changed to a status indicator N, meaning that the payment is packaged into the APC rate for other services. Therefore, a separate APC payment is no longer available for these IVUS codes. • Imaging supervision and interpretation for non-coronary stenting has been changed to a status indicator N, meaning that the payment is packaged into the Table 2. Comparison of 2008 vs. 2007 Payment Rates for Common Pacemaker and Defibrillator Procedures Procedure Single chamber pacemaker system implant Single chamber pacemaker generator only Dual chamber pacemaker generator only Dual chamber pacemaker implant ICD generator only ICD system LV lead only – at time of implant APC 0089 0090 0654 0655 0107 0108 0418 2008 APC Medicare National Payment $7,748 $6,423 $6,961 $8,919 $21,262 $25,787 $16,544 2007 APC Medicare National Payment $7,602 $6,042 $6,932 $9,382 $16,632 $22,334 $18,888 % Change (decrease) 1.9% 6.3% 0.4% (4.9%) 27.8% 15.5% (12.4%)

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Cath Lab Digest - March 2008 Are You Being Paid Fair Market Value in 2008? A Cardiac Cath Lab Professionals Survey by Cath Lab Digest and the Society of Invasive Cardiovascular Professionals Saint Joseph’s Hospital Invasive Imaging Tools for Optimizing Coronary Stent Deployment Contents Clinical Editor’s Corner A Workflow Revolution in Cath Lab Reporting Advantages of a New Digital Lab at Baystate Medical Center Cardiac Computed Tomography: What Does it Mean for the Cath Lab? The Latest in Cardiac Magnetic Resonance Imaging (MRI) Cellular Cardiomyoplasty and Cardiac Regeneration Intravascular Ultrasound in the Cath Lab: A Powerful — and Underutilized — Tool to Improve Patient Outcomes The Stentplus™ Patient Success Program Cardiac Cath Lab Clutter — or, Spring into Action! Groin Bleeds and Other Hemorrhagic Complications of Cardiac Catheterization: A List of Relevant Issues Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab What Do You Think? Experience with a New Guidewire: The Terumo Runthrough NS The Ostial Pro™ Stent Positioning System: Perfecting Aorto-Ostial Stent Placement Precious Minutes The Ten-Minute Interview with…Mark Bowles, BSN, CCRN Vascular Care in the Cath Lab: Planning a Smooth Transition Cath Laughs CMS 2008 OPPS Final Rule Review An Extensive Set of Review Courses for the CCI Basic Science, Non-Invasive Echocardiography and Vascular, and ARDMS Ultrasound Exams Meetings Calendar CEU Education Center Clinical & Industry News STEMI Interventions Classifieds Advertisers Index

Cath Lab Digest - March 2008

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