Coding and Legislative Update. Sean P. Roddy, MD Professor of Surgery Albany Medical College Albany, NY

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1 Coding and Legislative Update Sean P. Roddy, MD Professor of Surgery Albany Medical College Albany, NY

2 DISCLOSURES Sean Roddy, MD No relevant financial relationship reported

3 Medicare Conversion Factor Total RVUs x CF = procedural payment 2016 $ MACRA 0.5% 2014 SGR patch (ABLE statute) 0.18% Radiology advanced imaging MPPR 0.07% Budget neutrality 0.013% NET CHANGE 0.24% 2017 $ planned increase

4 CMS Proposed Mandatory Postoperative Care Reporting Major surgeries are valued based on specified # of hospital and office visits in the 90 days post-op In 2016, CMS proposed to disaggregate the 90-day global period after surgery (assumed to be inflated) Legislation overrode that proposal but requested CMS use an alternate method to identify typical postoperative care for major procedures

5 2017 CMS Final MPFS Rule Postoperative Care Reporting CPT code used for visits starting 7/1/2017 Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon, and Rhode Island Practices with < 10 practitioners are exempted Codes reported to CMS > 10,000 times or have allowed charges in excess of $10 million annually 34802, 34825, 35301, 36470/1, 36558, 36819, 36821, 36830, 36832, 37607, 37765, RAND also doing phone interviews to correlate data Assess the level and acuity of the visit

6 2017 CMS Final MPFS Rule Postoperative Care Reporting Potential only for under-reporting of the true number of post-op visits no potential for overreporting Many clearinghouses still do not accept claims so CMS may never see these submissions Uncompensated burden in those 9 states Most societies have objected to this SVS will need to monitor and react accordingly

7 Exercise Therapy For Claudication CMS proposed to cover supervised exercise therapy for beneficiaries with claudication Face-to-face visit with physician responsible for PAD Rx Requires: minutes sessions comprised of a therapeutic exercise-training program Three sessions per week Up to 12 weeks of sessions Must be conducted in a hospital or outpatient hospital

8 Exercise Therapy For Claudication Positive: Patients may now get exercise therapy in an approved setting to assist in quality of life Negative: No current CPT code for physician oversight payment Cannot be done in a physician office setting May lead to mandatory treatment before endovascular or open surgical revascularization (similar to varicose vein coverage policies) Await publication of the CMS final rule

9 Vascular Lab Payments Deficit Reduction Act DRA of 2005 DRA caps office-based technical payment for ultrasound since 2007 at the lesser of: Hospital Outpatient Payment Fee Schedule versus Medicare Physicians Fee Schedule The APCs for vascular lab payments were completely overhauled for 2017 by CMS

10 Hospital Vascular Lab Technical APCs in 2016 Vascular Lab Ultrasound Studies 1. APC 5531 Level 1 Ultrasound and Related Services 2. APC 5532 Level 2 Ultrasound and Related Services

11 Hospital Vascular Lab Technical APCs in 2017 Vascular Lab Ultrasound Studies 1. APC 5531 Level 1 Ultrasound and Related Services 2. APC 5532 Level 2 Ultrasound and Related Services

12 Hospital Vascular Lab Technical APCs in 2017 Vascular Lab Ultrasound Studies 1. APC 5522 Level 2 Imaging without Contrast 2. APC 5523 Level 3 Imaging without Contrast

13 APC Ultrasound Technical Payments Limited studies 2016 APC 5531 $ APC 5522 $ Complete studies 2016 APC 5532 $ APC 5523 $225.81

14 Vascular Lab Technical Payments CPT 2016 TC 2017 TC % Change Code Description $154 $165 7% Bilateral carotid $154 $165 7% Bilat venous extremity $154 $223 45% Bilateral LE arterial $154 $170 10% Bilateral UE arterial $154 $226 47% Complete abdominal $92 $113 23% Hemodialysis access

15 CPT and RUC 2017 New AAA screening CPT code Replaces the previous HCPCS G0389 code for Medicare beneficiaries

16 2017 AAA Screening Coding trvu trvu CPT wrvu Description -26 -TC AAA Screening U/S Subject to insurance carrier coverage limitations 2017 Medicare CF is $

17 CPT and RUC 2017 Mechanochemical Ablation Follows the same structure as RF and laser

18 2017 MOCA Coding CPT wrvu trvu facility trvu nonfacility Description MOCA, first vessel MOCA, subsequent vessel(s) 2017 Medicare CF is $

19 CPT and RUC 2017 Hemodialysis access diagnostic angiography and endovascular intervention Identified as potentially misvalued Nine new CPT codes were created Catheterization(s), angiography, and all endovascular intervention(s) bundled Access declots no longer assigned a 90- day global period

20 AV Access Imaging and Treatment Summary BASE diagnostic with no thrombectomy, no peripheral PTA or stent diagnostic + peripheral PTA diagnostic + peripheral stent +/- any peripheral PTA access thrombectomy with no peripheral PTA or stent access thrombectomy + peripheral PTA access thrombectomy + peripheral stent +/- any peripheral PTA ADD-ONs central PTA central stent +/- any central PTA embolization and all catheterization required for embolization

21 CPT wrvus Fac trvus NF trvus Code Description AV access angio Peripheral PTA Peripheral stent (+/- PTA) AV access declot Declot + periph PTA Declot + periph stent (+/- PTA) Central vein PTA Central vein stent (+/- PTA) AV access branch embolization 2017 MPFS values; 1 RVU = $

22 CPT and RUC 2017 Angioplasty outside the lower extremity Identified as potentially misvalued Includes: Aortic, upper extremity arterial, visceral artery, and venous PTA Four new codes were created bundling the procedure code and the radiology S&I Catheterization was left separately billable Mirrors the generic intravascular stent coding outside the lower extremity (eg, )

23 Angioplasty Outside The Lower Extremity New 2017 Codes CPT code Initial arterial PTA Base code CPT code Add-on code Additional arterial PTA CPT code Base code Initial venous PTA CPT code Add-on code Additional venous PTA

24 2017 PTA Coding CPT wrvu trvu facility trvu nonfacility Description Artery, first vessel Artery, subsequent vessel Vein, first vessel Vein, subsequent vessel 2017 Medicare CF is $

25 2018 Potential CPT Code Changes Infrarenal EVAR bundling Tube vs. Aorto-uni vs. Aorto-bi configurations Ruptured vs. non-ruptured Percutaneous vs open access Endovenous ablation coding additions Foam sclerosant ablations Chemical adhesive ablations

26 SVS APM Development Committee Ad-hoc committee designed to propose a vascular surgery specific APM for SVS members Chaired by Yazan Duwayri Representatives from Coding, Quality, and Government Relations committees Reviewing other published APMs and possible SVS APM possibilities More to come..

27 Conclusions Medicare CF increased by 0.24% Several vascular lab technical payments increased due to the HOPPS APC changes Significant coding changes in 2017 and 2018 New AAA screening code HD access angiography and PTA outside the LE EVAR changes and vein ablation new coding Postoperative care reporting will be required in specific states as of July 1, 2017