EP Lab Digest - April 2008 - (Page 41)

APRIL 2008 CMS NEWS 41 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 APC rate for the stenting itself. Therefore, a separate APC payment is no longer available for the imaging supervision and interpretation. Other imaging and supervision codes, including diagnostic angiograms, have been changed to a status indicator Q, meaning that they are separately payable only when specific criteria are met. Below are two short description of scenarios involving angiograms and how/if they would be payable: Diagnostic angiograms: In this example, we are assuming that multiple angiograms were performed in the lower extremity: - 2007: Each angiogram mapped to • • • an APC and every line item was paid at 100% of its APC value. - 2008:The highest-value procedure is paid at 100% of its APC value and all other eligible codes are packaged into that one payment. • Angiograms occurring during an intervention: In this example, we are assuming that multiple angiograms were performed in the lower extremity while an angioplasty also occurred: - 2007: Each angiogram mapped to an APC and every line item was paid at 100% of its APC value. The radiological supervision and interpretation for the angioplasty was mapped to an APC and was paid at 100% of its APC value. - 2008: The angioplasty’s APC code has a status indicator of “T”, thereby resulting in all codes with status Q being packaged into the angioplasty’s payment. There is no separate payment for any radiological supervision and interpretation. when an “Item is Provided Without Cost to Provider, Supplier or Practitioner” (Examples, but not Limited to: Covered Under Warranty, Replaced Due to Defect, Free Samples). This year, a new “FC” modifier was created for use when a “Qualifying Partial credit is received for a replaced device.” Hospitals are instructed to append the modifier to the procedure code [not the device code] that reports the services provided to replace the device. Services that require a modifier [FB or FC] are shown in Table 1 (Source: Medicare Table 26). 1. Aspirin at Arrival 2. Median Time to Fibrinolysis 3. Fibrinolytic Therapy Received Within 30 Minutes of Arrival 4. Median Time to Electrocardiogram (ECG) 5. Perioperative Care:Timing of Antibiotic Prophylaxis 6. Perioperative Care: Selection of Prophylactic Antibiotic 7. Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus In summary, while payments for outpatient cardiovascular procedures have moderate fluctuations for 2008, administrative vigilance is necessary to ensure that all coverage, coding and charging practices are compliant with federal regulations. If you need additional assistance in understanding these changes to EPrelated procedures, please contact Medtronic’s CRDM Healthcare Economics personnel through our coding hotline (1.866.877.4102, option 1) or website (www.Medtronic.com/ CRDMreimbursement ). If you have any questions related to coronary or peripheral vascular procedures, please contact Medtronic CardioVascular at: http://www. medtronic.com/cvreimbursement. Reimbursement Rates for 2008 The financial impacts of the changes to the device-related APCs are summarized in Tables 2 and 3. Quality Monitoring In addition to the reimbursement changes previously described as being effective January 1, 2008, reporting of quality measures begins April 1, 2008. In order to receive a full payment update in CY 2009, participating hospitals must collect data on seven required measures if they have cases meeting the data collection specifications.The Joint Commission requires accredited hospitals to collect and submit data on at least 4 quality measure sets for discharges in 2008. The seven measures include: Partial Credit Devices One other key change that is applicable to all device-related services is the addition of a new modifier for partial credit devices. In 2007, Medicare implemented the “FB” modifier for use • Data Sources Table 3. Comparison of 2008 vs. 2007 Payment Rates for Coronary and Peripheral Vascular Interventions Procedure Coronary Diagnostic Cardiac Catheterization Coronary or Non-Coronary Atherectomy Coronary or Non-Coronary Angioplasty Transcatheter Placement of Intracoronary Stents Transcatheter Placement of Intracoronary DrugEluting Stents Peripheral Non-Coronary Angioplasty or Atherectomy 0081 See APC 0082 See APC 0083 $5,574 $2,891 $2,469 $5,639 $1,839 $2,848 DELETED $2,639 0080 0082 0083 0104 0656 $2,479 $5,574 $2,891 $5,670 $7,543 $2,278 $4,438 $3,614 $5,392 $6,657 8.8% 25.6% (20.0%) 5.2% 13.3% APC 2008 APC Medicare National Payment 2007 APC Medicare National Payment % Change (decrease) • CMS November 1, 2007. Press Release “New Steps to Encourage Efficiency and Quality for Medicare Hospital Outpatient Services in 2008.” Available at http://www.cms. hhs.gov/apps/ media/press_releases.asp • CMS Display Copy. Available at: http://www.cms.hhs.gov/Hospital OutpatientPPS/HORD/list.asp#To pOfPage • November 27, 2007 Federal Register Copy. Available at: http://www.access. gpo.gov/ su_docs/fedreg/a071127c.html • Quality monitoring information. Available at: http://www.jointcommission.org/NewsRoom/NewsRel eases/nr_111507.htm Coronary or Non-Coronary Atherectomy Coronary or Non-Coronary Angioplasty Thrombectomy Transcatherter Placement of Intravascular Shunts Level II Angiography and Venography Level III Angiography and Venography 0082 0083 0088 0229 0279 0280 See APC 0081 See APC 0081 $2,320 $4,209 $584 $1,280 $2,001 111.2% 9.5% 6.4% 34.0% 214.8% 122.5% (100.0%) This article was reprinted with permission from Cath Lab Digest 2008;16(3):76-78. Level I Intravascular and Intracardiac Ultrasound and 0416 Flow Reserve http://www.Medtronic.com/CRDMreimbursement http://www.Medtronic.com/CRDMreimbursement http://www.medtronic.com/cvreimbursement http://www.medtronic.com/cvreimbursement http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=2586&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=false&cboOrder=date http://www.cms.hhs.gov/HospitalOutpatientPPS/HORD/list.asp#TopOfPage http://www.acess.gpo.gov/su_docs/fedreg/a071127c.html http://www.jointcommission.org/NewsRoom/NewsReleases/nr_111507.htm http://www.jointcommission.org/NewsRoom/NewsReleases/nr_111507.htm

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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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