EP Lab Digest - April 2008 - (Page 40)

40 CMS NEWS APRIL 2008 CMS 2008 OPPS Final Rule Review John Rader, Jennifer Williams, Susan Heilman Healthcare Economics, Medtronic, Inc. Minneapolis, Minnesota 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. 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) AICD, other than single or dual (C1882) Pacemaker, single, non rate responsive (C2620) Pacemaker, dual, rate responsive (C1785) Event recorder, cardiac (C1764) Lead, pacemaker, transvenous VDD (C1779) Pacemaker, dual, non rate responsive (C2619) Pacemaker, other than single or dual (C2621) Lead, AICD, endo single coil (C1777) A Lead, pacemaker, other than transvenous (C1898) Lead, pacemaker, pacemaker/ICD combination (C1899) Lead, AICD, non single/dual (C1896) Lead, AICD, endo dual coil (C1895) 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 copayment amount for hospital outpatient services. • Packaging of supportive ancillary services, including imaging supervision and interpretation, for noncoronary vascular procedures. The Joint Commission requires accredited hospitals to collect and submit data on at least 4 quality measure sets for discharges in 2008. (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 noncoronary 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 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 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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EP Lab Digest - April 2008 Pediatric Electrophysiology Medical Relief Work on the Yucatan Peninsula: A Labor of Love EP 101: Considerations for the Elderly EP Patient Contents Letter from the Editor Spotlight Interview: University of Maryland A Summary of the ACC/AHA/Physician Consortium 2008 Clinical Performance Measures for Adults with Nonvalvular Atrial Fibrillation or Flutter Can Psychosocial Characteristics Predict Fatal Outcomes in Patients? Interview with Jonathan S. Steinberg, MD, FACC 10-Minute Interview: Diane D. Sheffield, RN, BSN AED Access for All: An Organization for SCA Survivors New Column: 5 Quick Clues to AV Nodal Reentry Tachycardia CMS 2008 OPPS Final Rule Review New Online AED and CPR Training Opportunities: Q & A with Keith Weaver Highlights from the 5th Annual International Arrhythmia Winter School Email Discussion Group Events Calendar Second Annual Salary Survey Industry News and Products Classifieds Advertisers Index

EP Lab Digest - April 2008

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