2010 CPT Updates for Cardiology

Transcription

1 2010 CPT Updates for Cardiology Presented by: Betty Johnson, CPC, CPC I, CPC H, CDERC, CCS P, PCS, CCP, RMC, CIC CMS THE RUC PROCESS The RUC, SpecialtySociety Society Relative Value Scale Update Committee, is an independent group that makes recommendations to CMS It is an expert panel comprised of 29 members Is supported by an Advisory Committee of 100 specialty societies and health care professional organizations CMS has adopted 95% of its work value recommendations 2

2 CMS In 2006 the Medicare Payment Advisory Commission (MedPAC) sited concerns over the RUC s ability to identify overvalued services, so a Five Year Review Identification Workgroup was created (the Workgroup). In 2008 it was approved for the Workgroup to conduct reviews on an ongoing basis. The Workgroup and CMS have identified over 600 services to date 3 CMS The screens that have been used to date are: Site of Service Anomalies High Volume Growth CMS Fastest Growing Procedures High IWPUT Services Surveyed by One Specialty and Now Performed by a Different Specialty Harvard Valued Codes Inherently Performed Together 4

3 CMS Out of the more than 600 services identified by the Workgroup, 413 codes have completed the review process. Work and PE Maintained 130 Work Increased 29 Work Decreased 125 Direct Practice Expense Reviewed 105 Deleted from CPT 24 5 CPT THE MANUAL RENUMBER OR RESEQUENCE? Terminology v. Numbers Traditionally when new codes were added within a grouping, if there was not room in the sequence, the existing codes were deleted, renumbered, and added to a section including the new services Labor intensive on many fronts (encounter forms, claims software, etc.) & running out of numbers BJ&A ALL RIGHTS RESERVED. 6

4 CPT THE MANUAL New concept of resequencing Terminology based instead of numerically based Less affect in electronic format Look at page pg 110 Appendix N (p 585 of CPT Professional Edition) BJ&A ALL RIGHTS RESERVED. 7 CPT MANUAL Anatomy templates moved to corresponding section of CPT for ease of use Table of contents at the beginning of each section: not as replacement for alphabetic index, but as an addition NO modifier additions or deletions 8

5 CPT THORACIC INTRODUCTION AND REMOVAL P Removal of indwelling tunneled pleural catheter with cuff ʘ Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple 9 CPT THORACIC Tunneled pleural catheters used to be placed primarily for malignant pleural effusions at the end of a patient s life. Use has been expanded and the catheter is used for many other reasons now. Removing the catheter following resolution of the pleural effusion improves quality of life for the patient by removing the possibility of infection. Code does not include payment for the incisions and dissection required to remove the device, therefore the new code was created. 10

6 CPT THORACIC is reported once, regardless of the number of devices placed Moderate sedation is bundled Supply of the interstitial device is separately reportable Imaging guidance is not bundled 11 CPT THORACIC DESTRUCTION P Instillation(s), via chest tube/catheter, agent for fibrinolysis (eg, fibrinolytic agen for break up of multiloculated effusion); initial day subsequent day 12

7 CPT THORACIC Pleurodesis is the introduction of an agent into the pleural space to get the visceral pleura of the lung to stick to the parietal pleura of the chest wall so the lung won t collapse. Fibinolysis is the introduction of an agent into the pleural space to break up debris or fibrin within the chest to free up an entrapped lung. Fibrinolysis typically takes three days of treatment Insertion of the chesttube tube is separatelyreported reported with32551 Fibrinolysis is coded once per day, even though multiple treatments may be given on one day. 13 TRANSPOSITION OF THE GREAT VESSELS Aortic root translocation with ventricular septal defect and pulmonary stenosis repair (i.e., Nikaidoh procedure); without coronary ostium reimplantation with reimplantation of 1 or both coronary ostia 14

8 Pediatric surgery Rare surgeries 2/3 of 1 percent of all congenital heart abnormalities 90 global days wrvu wrvu 15 CARDIAC ASSIST DEVICES Replacement of extracorporeal ventricular assist device, single or biventricular, pump(s), single or each pump Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, without cardiopulmonary bypass implantable intracorporeal, single ventricle, with cardiopulmonary bypass 16

9 Extracorporeal outside the body Intracorporeal inside the body Replacement of VAD pump includes removal of the pump, insertion of new pump, connection, de airing and initiation of new pump Replacement of entire VAD system, i.e., pump(s) and cannulas, is reported using the insertion codes. Removal of the VAD system being replaced is not separately reportable (unlike pacemaker). 17 VASCULAR INJECTION PROCEDURES ʘ Introduction of needle and/or catheter, arteriovenous shunt created for dialysis; initial access with complete radiological evaluation of dialysis access, including fluoroscopy, image documentation and report (includes access of shunt, injection(s) of contrast, and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava ʘ additional access for therapeutic intervention 18

10 Report and for arteriovenous (AV) shunting If the main procedure indicates the need for a therapeutic intervention requiring a second catheterization of the shunt, report and Do not report with 75791, Angiography, arteriovenous shunt (eg, dialysis patient fistula/graft)complete evaluation of dialysis access, including fluoroscopy, image documentation and report, radiological supervision and interpretation 19 LIGATION Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Unilateral procedure Less radical than the Linton-type procedure (37760) 90 day global 9.13 w RVUs 20

11 Do not report with the following: US guidanceintraoperative intraoperative US guidance vascular US guidance needle Duplex scan of the extremity 21 CARDIOGRAPHY MEDICINE SECTION p 458 New Heading Cardiovascular Device Monitoring Implantable and Wearable Devices CHANGED TO: Implantable and Wearable Cardiac Device Evaluations 22

12 New guidelines for the section Base days for procedures remain the same: Atleast30daysfortheupto90daycodes Atleast10daysfortheupto30daycodes Electrocardiographic rhythm derived elements Interrogation device evaluation (not just face to face) face) Programming device evaluation (in person) (no technology to perform remotely currently) 23 ECHOCARDIOGRAPHY p 462 Guidelinesrevisions on M mode examination Sometimes M mode images not obtained and CPT wanted to make it clear that a comprehensive could still be used When stress echo is performed with complete cardiovascular stress (93015), use Code is used to report the performance and interpretation of stress echo only, with the components of the cardiovascular stress test reported separately with the appropriate codes ( ). 24

13 NONINVASIVE PHYSIOLOGIC STUDIES AND PROCEDURES P Bioimpedence-derived physiologic cardiovascular analysis Previously, the code only described thoracic electrical bioimpedence in which electrodes are attached to the thorax for measurement.the revised code allows for reporting when measuring bioimpedence when the electrodes are attached to the wrist and ankle. 25 NONINVASIVE PHYSIOLOGIC STUDIES AND PROCEDURES Interrogation of ventricular assist device (VAD) in person, with physician analysis of device parameters (eg, drivelines, alarms, power surges), review of device function (eg, flow and volume status, septum status, recovery), with programming, if performed, and report Instructional notes instruct users not to report with 33975, 33976, 33979, , VAD insertion, removal, and replacement codes. 26

14 RADIOLOGY HEART P Cardiac magnetic resonance imaging for velocity flow mapping (List separately in addition to code for primary procedure) Eight new codes were created in 2007, but half included flow velocity, which has been deemed non-covered by CMS. As such, CPT codes 75558, 75560, 75562, and have been deleted. Instead, the new add-on code will be used with 75557, 75559, 75561, and RADIOLOGY HEART Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3-D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed) 28

15 RADIOLOGY HEART Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D imaging postprocessing, assessment of LV cardiac function, RV structure and function and evaluation of venous structures, if performed) Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed) 29 Four new codes Replace 8 Category III codes 0144T 0151T No contrast quick study pt. just takes a deep breath can have their clothes on with contrast congenital heart disease with CT coronary angiography Guidelines state that only one CT heart service may be reported per encounter p 357 Do not report with (3D rendering) bundled 30

16 VASCULAR PROCEDURES AORTA & ARTERIES p Angiography, arteriovenous shunt (eg, dialysis patient fistula/graft), complete evaluation of dialysis access, including fluoroscopy, image documentation and report (includes injections of contrast and all necessary imaging from the arterial anastomosis and adjacent artery through entire venous outflow including the inferior or superior vena cava), radiological supervision and interpretation 31 VASCULAR PROCEDURES AORTA& ARTERIES p360 Due to new codes 36147/36148, this code was added to indicate an evaluation through an already existing access site into the shunt, or from an access site that is not a direct puncture of the shunt Instructional notes in both sections indicate that 36147/36148 should not be reported with

17 NUCLEAR MEDICINE CARDIOVASCULAR SYSTEM p Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic) multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection 33 NUCLEAR MEDICINE CARDIOVASCULAR SYSTEM p Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic) multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection 34

18 Three codes, (SPECT imaging, multiple), (wall motion), and (ejectionfraction) were reviewed by the RUC because they were reported together over 95 percent of the time The RUC recommended that the services be combined with on fee. The four new codes ( ) replace six old codes (78460, 78461,78464, 78465, 78478, and 78480) 35 RESOURCES CPT 2010, Professional Edition, AMA CPT Changes 2010: An Insider s View, AMA CPT Symposium 36

19 QUESTIONS? THANK YOU FOR YOUR TIME! Betty Johnson, CPC, CPC I, CPC H, CDERC, CCS P, PCS, CCP, RMC, CIC Betty Johnson & Associates, Inc Southwest Highway, Suite 6 Palos Hills, IL betty@bettyjassociates.com 37