Medicare Hospital Outpatient Changes Effective January 1, 2013

Transcription

1 Medicare Hospital Outpatient Changes Effective January 1,

2 This presentation is intended for education use. Any duplication is prohibited without written consent of Medtronic s Economic Strategies and Solutions department. This information does not replace seeking coding advice from the payer and/or your coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for their interpretation of the appropriate codes to use for specific procedures. Medtronic makes no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third party payers as to the correct form of billing or the amount that will be paid to providers of service. CPT copyright 2012 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restriction Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. Note: CPT code descriptions may be abbreviated and not listed in their entirety in all cases in this presentation. For full descriptions, please refer to your 2013 CPT code book. 2

3 Today s Agenda Executive Summary CPT and APC Changes for CRDM Procedures 2013 Medicare National APC Payments CRDM Payment Examples Reporting Device Credits to Medicare CPT and APC Changes for Vascular Procedures Contact Information Appendix Q & A 3

4 AAPC CEU Certification This program has prior approval of the American Academy of Professional Coders (AAPC) for 1.0 Continuing Education Unit (CEU). Granting of this approval in no way constitutes endorsement by AAPC of the program content or the program sponsor. An electronic survey will be sent to all participants within 2-3 business days of the Live Presentation session they attended. After finishing the survey, the participants will be directed to a site to download the certificate. It is mandatory by AAPC regulations for all attendees to attend the entire session in order to receive the survey. 4

5 Medtronic CRDM Economic Strategies and Solutions Department Our Mission To educate customers on the economically efficient use of our products and therapies. Our Goals Educate customers on coverage, coding, policy, and reimbursement issues. Create support programs that help providers understand how our products can be used in a cost-effective manner. Engage in collaboration and dialogue on economic issues that impact quality and patient access in the healthcare system. 5

6 Regional Economic Managers (REMs) 6

7 Executive Summary 7

8 Medicare CY 2013 OPPS Updates 1.8% Payment: $ CY 2013 conversion factor when meeting OQR* $ CY 2012 conversion factor (CF)** $ Hospital Outpatient Payment Increase Coding and APC assignment: Deleted: Codes (catheter ablation/svt) and (catheter ablation/vt) APC 0086 as a result of deleted codes and Added: five new catheter ablation CPT codes: 93653, 93654, plus Add-on codes and Sources: Fact Sheets, CY 2013 OPPS Final Rule, CPT code book See Appendix * Hospital OQR (Outpatient Quality Reporting) Program ** 2012 CF revised Federal Register /Vol. 77, No. 2 /Wednesday, January 4, 2012 /Rules and Regulations 8

9 2013 Payment Determination Quality Measures The CY 2013 payment determination originally included twentythree quality measures however OP-19 was suspended and OP-15 was postponed. See Appendix for the quality measures. OP-16 measure will be removed effective January 1, 2013 Troponin results for Emergency Department AMI patients or chest pain patients (with probable cardiac chest pain) received within 60 minutes of arrival Sources: Fact Sheets, CY 2013 OPPS Final Rule, CPT code book; See Appendix 9

10 CPT and APC Changes for CRDM Procedures 10

11 2013: Two Deleted CPT Codes CPT CPT code description Deleted codes effective January 1, Intracardiac catheter ablation of arrhythmogenic focus; for treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination Intracardiac catheter ablation of arrhythmogenic focus; for treatment of ventricular tachycardia WHY? 2013 CPT code book 11

12 New Ablation Codes Primary and Add-on CPT added three new primary ablation codes that combine the elements of the EP study with the ablation procedure: 1. EPS plus SVT (supraventricular) ablation 2. EPS plus VT (ventricular tachycardia) ablation 3. EPS plus PVI (Pulmonary Vein Isolation for A-fib) To accommodate treatment of additional lesions after the primary code, CPT added 2 new add-on codes: 1. Ablation of additional discrete mechanism, or SVT or VT remaining after the primary procedure. 2. Additional ablation (linear or focal) to treat AF remaining after PVI. CPT for AV (atrioventricular node) ablation remains unchanged Let s take a closer look! 12

13 2013 : Five New CPT Codes CPT CPT code description New codes effective January 1, Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording, His recording with intracardiac catheter ablation of arrhythmogenic focus; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry (Do not report in conjunction with , 93610, 93612, , 93642, 93654) 2013 CPT code book Combines EP study and SVT ablation and includes: Induction or attempted induction of arrhythmia Right atrial pacing and recording Right ventricular pacing and recording His bundle recording SVT ablation 13

14 2013 New CPT Codes CPT CPT code description New codes effective January 1, Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording, His recording with intracardiac catheter ablation of arrhythmogenic focus; with treatment of ventricular tachycardia or focus ventricular ectopy including intracardiac electrophysiologic 3D mapping, when performed, and left ventricular pacing and recording, when performed (Do not report in conjunction with , , , 93609, 93610, 93612, 93613, , 93622, 93642, 93653) 2013 CPT code book Combines EP study and ablation for VT and includes: Induction or attempted induction of arrhythmia Right atrial pacing and recording Right ventricular pacing and recording His Bundle recording VT ablation And when performed: 3D mapping (93613) LV pacing and recording (93622) 14

15 2013 New CPT Codes CPT CPT code description New codes effective January 1, Comprehensive electrophysiologic evaluation including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with atrial recording and pacing, when possible, right ventricular pacing and recording, His bundle recording with intracardiac catheter ablation of arrhythmogenic focus, with treatment of atrial fibrillation by ablation by pulmonary vein isolation (Do not report in conjunction with , , 93462, 93600, 93602, 93603, 93610, 93612, 93618, 93619, 93620, 93621, 93653, 93654) 2013 CPT code book Combines EP study and PVI and includes: Induction or attempted induction of arrhythmia Transseptal catheterization(s) Right ventricular pacing and recording His Bundle recording PVI (Pulmonary Vein Isolation) And when possible: Right atrial pacing and recording 15

16 2013 New CPT Codes CPT CPT code description New codes effective January 1, Intracardiac catheter ablation of a discrete mechanism of arrhythmia which is distinct from the primary ablated mechanism, including repeat diagnostic maneuvers, to treat a spontaneous or induced arrhythmia (Use in conjunction with 93653, 93654, 93656) Add-on code : May be reported with 93653, 93654, CPT code book 16

17 2013 New CPT Codes CPT CPT code description New codes effective January 1, Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (Use in conjunction with 93656) Add-on code : May be reported with CPT code book 17

18 What codes remain separately billable with each of the new Ablation Codes? CPT Code Brief Description SVT X = may be separately billable VT Standard (2D) mapping Not reportable with X D mapping X Not reportable with Left atrial pacing/recording X X LV pacing/recording X X Isuprel infusion X X X Transseptal catheterizations X X PVI Additional ablation(s) after X X X basic ablation Additional ablation(s) after PVI X Intra cardiac Echo (ICE) X X X X X 2013 CPT code book 18

19 2013 APC Assignment for Single Encounter Single EPS or Catheter Ablation of AV Node CPT Brief Description APC 2013 APC 2012 % Change EPS without induction or EPS w/induction or Ablate AV node 0085 $3, $3, % Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

20 2013 APC Changes for CRDM Procedures CPT Brief Description (applicable for 2012) Catheter ablation of SVT or VT APC 2013 APC 2012 % Change NA CPT codes and APC 0086 deleted effective or 8000 NA Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

21 Composite Payments for EP Studies and Ablations Composite APC: Provides a single payment for all clinically-related services provided within an encounter or episode of care. Medicare may consider creating APCs for services that are frequently provided in the same encounter. The composite consists of codes from defined groups A, B, C: Group A: 93619, Group B: Group C: 93653, 93654, For 2013, Composite APC 8000 includes procedure codes in Group C Codes in Group C are new codes that have packaged EP study and ablation procedures. While they are mapped to the Composite APC 8000, only one of the new codes is required for the composite payment. 21

22 2013 Composite APC Assignment: Includes New CPT Codes in Group C Composite APC 8000 CPT Brief Description APC 2013 APC 2012 % Change Group A: At least one in Group A and Group B EPS without induction EPS with induction Group B: Ablate AV node Group C: At least one in Group C New New New EPS, Ablate SVT EPS, Ablate VT EPS, treatment of AF by pulmonary vein isolation ablation $11,146 $11, % $11,146 $11, % Source: OPPS Final rule Federal Register, Table 4, page Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

23 Documentation: Coding/Billing for New Ablation Codes When coding an EPS, if all the components of the code are not performed and documented, bill the component codes separately. 1 For the new composite ablation codes, consider reduced service modifier -52 when all the components of each code are not performed and documented. 2 Source: 1 HRS Coding Guide 2012, p CPT code book

24 2013 Medicare National APC Payments 24

25 Outpatient hospital APC payments show variability. National Medicare Hospital Outpatient Payment Rates for Significant Medtronic Therapies Therapy/CPT Code CY CY CY CY CY CY APC~ ^ ICDs (33249) $28,251 $27,728 $26,830 $29,767 $30, % APC 0108 composite composite CRT-Ds (33249 and ) APC 0108 & 0418/0655 $32, APC 0418 $34, APC 0418 $32, APC 0418 $29,767 composite $30,680 composite -6.5% Pacemakers (33208) APC 0655 $9,512 $9,559 $9,485 $9,693 $10, % Medicare national payment rates indicated are based on information included in the CMS Federal Registers for CY ~APC: Ambulatory Payment Classification; CPT copyright 2012 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restriction Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. ^ APC payment rates reflect changes based on the Affordable Care Act.. 25

26 CRDM Payment Examples 26

27 Status Indicators Status Indicator 1 Item/Code/Service 1 C M N S T Q3 X Inpatient Procedures. Not paid under OPPS. Admit patient. Bill as Inpatient. (e.g., 33203: Insertion of epicardial electrode(s); endoscopic approach) Items and Services Not Billable to the Fiscal Intermediary/MAC. Not paid under OPPS. (e.g., 93294, 93295, 93297, 93298) Items and Services Packaged into APC Rates. Paid under OPPS; payment is packaged into payment for other services. Therefore, there is no separate APC payment. (e.g., 93613, 93621, 93622, 93623, 93640, 93641, 93662) Significant Procedure, Not Discounted when Multiple. Paid under OPPS; separate APC payment. (e.g., 33282: Insert patient activated cardiac event recorder) Significant Procedure, Multiple Reduction Applies. Paid under OPPS; separate APC payment. (e.g., insert single transvenous lead) Codes that may be paid through a Composite APC. (1) Composite APC payment based on OPPS composite-specific payment criteria. (2) Separate APC payment or packaged into payment for other services. (e.g., 93656) Ancillary Services. Paid under OPPS; separate APC payment. (e.g., 93290: Interrogation device evaluation (in person); implantable cardiovascular monitor system) 1 Addendum D1 is available at: 27

28 Hospital OP coding ICD generator replacement 1,2 Replacement and defibrillator threshold testing of a single chamber ICD pulse generator that has reach end of life and the endocardial lead does not need to be replaced. Description CPT APC Payment SC ICD generator replacement (SI T) $22,512 Threshold Testing at Implant (SI N) NA Packaged Total Payment $22,512 Include applicable HCPCS C-Codes for device SC: Single Chamber 1 HRS 2012: Coding Guide for Heart Rhythm Procedures and Services, page CPT page 177, Professional Edition 28

29 Hospital OP coding Initial insertion of ICD 1,2 An asymptomatic patient with chronic ischemic heart disease and prior history of MI 8 weeks ago presents with LVEF < 35% after office evaluation and echo is referred for prophylactic (Primary Prevention) ICD implant. The patient receives a single chamber ICD without an EP study. The device is tested via defibrillator threshold testing at time of implant. Description CPT APC Payment SC ICD System Implant (SI T) Q $30,680 Threshold Testing (SI N) NA Packaged Total Payment $30,680 Include applicable HCPCS C-Codes for device and leads SC: Single Chamber 1 CPT 2013 page 177, Professional Edition 2 HRS 2012: Coding Guide for Heart Rhythm Procedures and Services, page 62 29

30 Hospital OP coding Upgrade ICD to Bi-V ICD 1 A patient with congestive heart failure is optimally managed on drug therapy. Based on the current condition of the patient, the physician determines Bi-Ventricular therapy is needed. This patient s existing ICD generator met secondary prevention ICD coverage. The patient s dual chamber ICD generator is removed, an LV lead is inserted along with the Bi-V ICD generator. The device is tested at time of implant. Description CPT APC Payment DC ICD gen. removed Bi-V ICD gen. inserted (SI T) $22,512 LV lead inserted (SI-T) $5,093 2 Threshold Testing (SI N) NA Packaged Total Payment $27,605 Include applicable HCPCS C-Codes for device and lead DC: Dual Chamber Bi-V: Biventricular / Cardiac Resynchronization Therapy 1 CPT 2013 page 177, Professional Edition 2 50% multiple procedure reduction 30

31 Hospital OP coding Remove and Replace LV lead 1 A dislodged left ventricular lead attached to a dual chamber system placed yesterday in the coronary sinus is removed and the left ventricular lead is replaced. Pacemaker recommended codes: for Bi-V CRT pacemaker lead insertion for Bi-V CRT pacemaker lead removal ICD recommended codes: for Bi-V CRT ICD lead insertion for Bi-V CRT ICD lead removal Modifier 78: Unplanned return to the Operating Room/Procedure Room by the Same Physician or Other Qualified Health Care Professional following Initial Procedure for a Related Procedure During the Postoperative Period 1 HRS 2012: Coding Guide for Heart Rhythm Procedures and Services, page 53 31

32 Hospital OP Coding: Ablation Example Documented SVT 1,2 Patient has recurrent palpitations. An event monitor has documented supraventricular tachycardia (SVT). Multielectrode catheters are advanced into the respective cardiac chambers where they will be used to pace & record. Pacing & sensing is performed in the RA and RV. His bundle recording is obtained. Refractory periods are measured. Attempts at arrhythmia induction are performed via maneuvers that include burst pacing and premature pacing using programmed electrical stimulation at multiple drive cycle lengths from multiple atrial and ventricular sites. Once the SVT is induced, pacing maneuvers are performed to elucidate the mechanism of the tachycardia. Once the combination of both diagnostics maneuvers and mapping is complete, catheter ablation may be performed. An ablation is maneuvered from the sites of vascular access to the appropriate cardiac location to facilitate delivery of ablative energy. Multiple lesions are delivered to ensure eradication of the arrhythmia focus and to provide consolidation lesions in the surrounding tissue. Throughout the ablation, the patient is monitored for hemodynamic compromise due to cardiac perforation, bradyarrhythmias, or tachyarrhythmias, embolic phenomena, or damage to cardiac or vascular structures. Following the ablation portion of the procedure, further electrophysiologic testing is performed to assess the outcome of ablation using decremental, burst, and premature pacing maneuvers. These are repeated following a 30-minute period following the conclusion of the final ablation lesion. Sheaths are removed, appropriate hemostasis is achieved, and followup assessment of the patient for any complications is performed. Description CPT APC Payment Treatment of SVT(composite) $11,146 (Do not report in conjunction with , 93610, 93612, , 93642, 93654) Include applicable HCPCS C-Codes for catheters 1 CPT Changes An Insider s View, page CPT page , Professional Edition 32

33 SVT Ablation Example: CPT Brief Description Induction or attempted induction of arrhythmia RA pacing/recording RV pacing/recording His bundle recording SVT ablation Required for SVT Ablation X X X X X Documentation supports that all components of CPT were performed Add-on code may be reported with CPT code book 33 33

34 VT Ablation: CPT Brief Description Induction or attempted induction of arrhythmia RA pacing/recording RV pacing/recording His bundle recording VT ablation 3D mapping LV pacing/recording Required for VT Ablation X X X X X X When performed X When performed Documentation supports that all components of CPT were performed Add-on code may be reported with CPT code book 34 34

35 PVI Ablation: CPT Brief Description Induction or attempted induction of arrhythmia Transseptal catheterizations RV pacing/recording His bundle recording PVI Atrial pacing/recording Required for PVI X X X X X X When performed Add-on codes and may be reported with Documentation supports that all components of CPT were performed 2013 CPT code book 35 35

36 Reporting Device Credits to Medicare 36

37 OIG Audits Device Credits OIG (Office of Inspector General) audits have disclosed that hospitals are not always reporting device credits consistently and accurately According to OIG findings: Medicare providers are expected to pursue free replacements or reduced pricing under warranties. Hospitals should ensure that there are policies and procedures in place to track and appropriately report device credits. 37

38 Medicare Device Credit Patient Example 1 FB Modifier FC Modifier CY 2013 APC and CPT code CY 2013 APC Title Final CY 2013 Device Offset % for No Cost / Full Credit Case Final CY 2013 Device Offset % for Partial Credit Case 0654 (CPT 33228) (remove and replace generator) Level II Insertion/ Replacement of Permanent Pacemaker 74% 1 $2,006 Payment ($7,715 *.74 = $5,709; $7,715 - $5,709 = $2,006) 37% 1 $4,860 Payment ($7,715 *.37 = $2,855; $7,715 - $2,855 = $4,860) Medicare national payment rate for APC 0654 is $7,715 1 OPPS Final Rule, page of the Federal Register dated November 15, 2012 Table 29: APCs to which the no cost/full credit and partial credit device adjustment policy will apply in CY 2013, pages

39 Hypothetical UB-04 Claim Submission FB modifier: FB Procedure charge determined by hospital C1785 Device charge, determined by hospital ~ < $1.01 FC modifier: FC C1785 Procedure charge determined by hospital Device charge, determined by hospital Condition code should also be included (49 or 50) OPPS Final Rule, page of the Federal Register dated November 15, 2012 Table 29: APCs to which the no cost/full credit and partial credit device adjustment policy will apply in CY 2013, pages Table 30 identifies the applicable C-Codes, page

40 Condition Codes 49 and 50 Condition Code 49: Product Replacement within Product Lifecycle Replacement of a product earlier than the anticipated lifecycle due to an indication that the product is not functioning properly. Condition Code 50: Product Replacement for Known Recall of a Product Manufacturer or FDA has identified the product for recall and therefore replacement. Source: CMS Manual Pub Medicare Claims Processing, Transmittal 741 dated November 4, 2005 is available at: 40

41 Full Credit for Only One Device Component Hypothetical Example The dual chamber pacemaker generator is recalled and needs to be replaced. The hospital received this pacemaker generator at no cost. During the implant, the physician determines that the Right Ventricular (RV) lead is at end of life so this lead is capped and a replacement RV lead is implanted at full cost to the hospital. Since the generator and at least one lead constitutes a system implant, the appropriate CPT code is Medicare provided clarification on the correct way to report this service: FB Hospitals should assign the FB or FC modifier to the procedure code, and the offset (payment reduction) will be applied to that particular service. OPPS Final Rule, page of the Federal Register dated November 15,

42 CPT and APC Changes for Vascular Procedures 42

43 Outpatient Payment: CY 2013 HOPPS National Unadjusted APC Code Description CY 2012 CY 2013 CORONARY 0080 Diagnostic Cardiac Catheterization $2,721 $2,650 (-2.6%) 0082 Coronary or Non-Coronary Atherectomy $7,365 $7,671 (4.2%) 0083 Coronary or Non-Coronary Angioplasty and Percutaneous Valvuloplasty $4,611 $4,023 (-12.8%) 0104 Transcatheter Placement of Intracoronary Stents (BMS) $5,694 $6,110 (7.3%) 0656 Transcatheter Placement of Intracoronary Drug-Eluting Stents $7,409 $7,763 (4.8%) PERIPHERAL / NON-CORONARY 0082 Coronary or Non-Coronary Atherectomy $7,365 $7,671 (4.2%) 0083 Level I Endovascular Revascularization of the Lower Extremity $4,624 $4,023 (-13.0%) 0088 Thrombectomy $2,874 $3,100 (7.9%) 0229 Level II Endovascular Revascularization of the Lower Extremity $8,096 $8,657 (6.9%) 0319 Level III Endovascular Revascularization of the Lower Extremity $14,210 $14,596 (2.7%) 0279 Level II Angiography and Venography $2,088 $2,220 (6.3%) 0280 Level III Angiography and Venography $3,478 $3,630 (4.4%) Sources: Addendum A for CY 2013 and the October 2012 release for CY Source: CY 2013 HOPPS Final Rule

44 Vascular Changes: New and Deleted CPT Codes Percutaneous Coronary Intervention (PCI) Codes 6 deleted PCI codes 92980, 92981, 92982, 92984, 92995, new PCI CPT codes 92920, 92921, 92924, 92925, 92928, 92929, 92933, 92934, 92937, 92938, 92941, 92943, new C-Codes for drug-eluting stents (DES) C C9608 Diagnostic Carotid Angiograms 8 new CPT codes 36221, 36222, 36223, 36224, 36225, 36226, 36227, deleted CPT codes 75650, 75660, 75662, 75665, 75671, 75676, 75680, Webinars on these updates: Held Dec 5 & 6 On Demand replay available at this site January update webinar TBD RSVP to jennifer.m.williams@medtronic.com 44

45 Medtronic economic resources include webcasts for hospitals & physicians on key topics 45

46 Contact Information 46

47 Medtronic Cardiovascular Contact Information Vascular Contact: Alex Au-Yeung: Or Jennifer Williams: Coding Hotline number: 1 (877) Submit a question: vascular-reimbursement-q.html 47

48 CRDM Information To ensure you receive advance notification of webcast events, it is very easy to register at Join our List Subscribe to receive news and updates. 48

49 Appendix 49

50 Data Sources CMS November 1, 2012 Fact Sheet: CMS Issues Outpatient Policy and Payment Changes The OPPS Final Rule Home Page for CY 2013 and CY 2012: Payment/HospitalOutpatientPPS/index.html November 15, 2012 Federal Register publication of the CY 2013 Final Rule (CMS-1589-FC) November 30, 2011 Federal Register publication of the CY 2012 Final Rule (CMS-1525-FC) April 24, 2012 Federal Register publication of the CY 2012 Corrections 50

51 Quality Measures Hospital OQR Program Measures for CY CY 2015 OP-1 Median time to fibrinolysis (2008) OP-2 Fibrinolytic therapy received within 30 minutes (2008) OP-3 Median time to transfer to another facility for acute coronary intervention (2008) OP-4 Aspirin at arrival (2008) OP-5 Median time to ECG (2008) OP-6 Timing of antibiotic prophylaxis (2008) OP-7 Prophylactic antibiotic selection for surgical patients (2008) OP-8 MRI lumbar spine for low back pain (2009) OP-9 Mammography follow-up rates (2009) OP-10 Abdomen CT use of contrast material (2009) 10 Measures 51

52 Quality Measures Hospital OQR Program Measures for CY CY 2015 OP-11 Thorax CT Use of Contrast Material (2009) OP-12 The ability for providers with HIT to receive laboratory data electronically directly into their qualified/certified EHR system as discrete searchable data (2011) OP-13 Cardiac imaging for preoperative risk assessment for non cardiac Low risk surgery (2012) OP-14 Simultaneous use of brain Computed Tomography (CT) and sinus Computed Tomography (CT) (2012) OP-15* Use of brain Computed Tomography (CT) in the emergency department for atraumatic headache (2012) OP-17 Tracking clinical results between visits (2012) * Information for OP-15 will not be reported in Hospital Compare in Public reporting for this measure will will occur in July 2013 at the earliest and this measure will not be used in the 2014 payment determination. 6 Measures; Total 16 Measures 52

53 Quality Measures Hospital OQR Program Measures for CY CY 2015 OP-18 OP-19** OP-20 OP-21 OP-22 OP-23 Median time from ED arrival to ED departure for discharged ED patients ( encounters) Transition record with specified elements received by discharged ED patients ( encounters) Door to diagnostic evaluation by a qualified medical professional ( encounters) ED - median time to pain management for long bone fracture ( encounters) ED patient left without being seen ( encounters) ED - head CT scan results for acute ischemic stroke or hemorrhagic stroke who received head CT scan interpretation within 45 minutes of arrival ( encounters) ** Data collection for OP-19 was suspended effective with January 1, 2012 encounters until further notice 6 Measures; Total 22 Measures 53

54 Quality Measures Hospital OQR Program Measures for CY CY 2015 OP-24*** Cardiac Rehabilitation Patient Referral from an Outpatient Setting ( ) OP-25 Safety Surgery Checklist ( ) OP-26 Hospital Outpatient Volume Data on Selected Outpatient Surgical Procedures ( ) (Procedure Category: Cardiovascular Corresponding HCPCS Codes: through 37999) *** Data collection for OP-24 is deferred from January 1, 2013 to January 1, 2014, and its first application toward a payment determination would be for CY 2015 rather than CY Measures; Total 25 Measures 54

55 CRDM CPT Code Description Changes CPT code CPT code description Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system and pocket revision) (List separately in addition to code for primary procedure) Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (List separately in addition to code for primary procedure) The cardiac device monitoring codes ( , ) had the following change: 2012 with physician analysis, review and report 2013 with analysis, review and report by a physician or other qualified health care professional 55

56 APC CRDM National Payment Comparisons CPT Brief Description APC 2013 and SI Insert pacer system; atrial Insert pacer system; ventricle Insert pacer system; A and V Insert temporary lead, single Insert temporary leads, dual Insert pacer gen. only; w/ single lead Insert pacer gen. only; w/ dual leads APC 0089 $8,230 (T) APC 0089 $8,230 (T) APC 0655 $10,187 (T) APC 0106 $3,766 (T) APC 0106 $3,766 (T) APC 0090 $6,612 (T) APC 0654 $7,715 (T) APC 2012 and SI APC 0089 $7,833 (T) APC 0089 $7,833 (T) APC 0655 $9,693 (T) APC 0106 $3,476 (T) APC 0106 $3,476 (T) APC 0090 $6,602 (T) APC 0654 $7,235 (T) % Change 5.1% 5.1% 5.1 % 8.3% 8.3% 0.2% 6.6% Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

57 APC CRDM National Payment Comparisons CPT Brief Description APC 2013 and SI Upgrade single pacer to dual pacer Reposition previously placed RA or RV lead Insert single lead, pacer/icd Insert 2 leads, pacer/icd Repair single lead, pacer/icd Repair 2 leads, pacer/icd Insert pacer gen. only; w/ multiple leads APC 0655 $10,187 (T) APC 0105 $1,683 (T) APC 0106 $3,766 (T) APC 0106 $3,766 (T) APC 0105 $1,683 (T) APC 0105 $1,683 (T) APC 0654 $7,715 (T) APC 2012 and SI APC 0655 $9,693 (T) APC 0105 $1,596 (T) APC 0106 $3,476 (T) APC 0106 $3,476 (T) APC 0105 $1,596 (T) APC 0105 $1,596 (T) APC 0654 $7,235 (T) % Change 5.1 % 5.5% 8.3% 8.3% 5.5% 5.5% 6.6% Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

58 APC CRDM National Payment Comparisons CPT Brief Description APC 2013 and SI Revise/relocate pacer skin pocket Revise/relocate ICD skin pocket Insert LV lead, attach to existing pacer/icd Insert LV lead at time of pacer/icd generator implant Reposition previously placed LV lead Remove pacer gen. and replace pacer gen.; single lead system APC 0136 $1,112 (T) APC 0136 $1,112 (T) APC 0655 $10,187 (T) APC 0655** $10,187 (T) APC 0105 $1,683 (T) APC 0090 $6,612 (T) APC 2012 and SI APC 0136 $1,172 (T) APC 0136 $1,172 (T) APC 0655 $9,693 (T) APC 0655** $9,693 (T) APC 0105 $1,596 (T) APC 0090 $6,602 (T) % Change -5.1% -5.1% 5.1% 5.1% 5.5% 0.2% ** Single Composite APC 0108 is applicable when ICD/CRT-D generator and leads are implanted on same date of service. Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

59 APC CRDM National Payment Comparisons CPT Brief Description APC 2013 and SI Remove pacer and replace pacer gen.; dual lead system Remove pacer and replace pacer gen.; multiple lead system Insert ICD gen. only; w/ existing dual leads Insert ICD gen. only; w/ multiple leads Remove pacer lead; single Remove pacer leads; dual APC 0654 $7,715 (T) APC 0654 $7,715 (T) APC 0107 $22,512 (T) APC 0107 $22,512 (T) APC 0105 $1,683 (T) APC 0105 $1,683 (T) APC 2012 and SI APC 0654 $7,235 (T) APC 0654 $7,235 (T) APC 0107 $24,290 (T) APC 0107 $24,290 (T) APC 0105 $1,596 (T) APC 0105 $1,596 (T) % Change 6.6% 6.6% -7.3% -7.3% 5.5% 5.5% Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

60 APC CRDM National Payment Comparisons CPT Brief Description APC 2013 and SI Insert ICD gen. only; w/ single lead APC 0107 $22,512 (T) Remove ICD gen. only APC 0105 $1,683 (T) Remove ICD leads; by transvenous extraction Insert or replace ICD system w/ transvenous leads, single or dual chamber Remove ICD and replace ICD gen.; single lead system APC 0105 $1,683 (T) APC 0108** $30,680 (T) APC 0107 $22,512 (T) APC 2012 and SI APC 0107 $24,290 (T) APC 0105 $1,596 (T) APC 0105 $1,596 (T) APC 0108** $29,767 (T) APC 0107 $24,290 (T) % Change -7.3% 5.5% 5.5% 3.1% -7.3% ** Single Composite APC 0108 is applicable when ICD/CRT-D generator and leads are implanted on same date of service. Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

61 APC CRDM National Payment Comparisons CPT Brief Description APC 2013 and SI Remove ICD and replace ICD gen.; dual lead system Remove ICD and replace ICD gen.; multiple lead system Insert patient-activated cardiac event recorder (ILR) APC 0107 $22,512 (T) APC 0107 $22,512 (T) APC 0680 $5,893 (S) Remove ILR APC 0020 $584 (T) APC 2012 and SI APC 0107 $24,290 (T) APC 0107 $24,290 (T) APC 0680 $5,633 (S) APC 0020 $579 (T) % Change -7.3% -7.3% 4.6% 0.9% Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

62 APC CRDM National Payment Comparisons CPT Brief Description APC 2013 and SI Cardioversion, external APC 0679 $400 (S) Cardioversion, internal APC 0679 $400 (S) Program device evaluation; single lead pacemaker system Program device evaluation; dual lead pacemaker system Program device evaluation; multiple lead pacemaker system Program device evaluation; single lead ICD system APC 0690 $33.95 (S) APC 0690 $33.95 (S) APC 0690 $33.95 (S) APC 0690 $33.95 (S) APC 2012 and SI APC 0679 $374 (S) APC 0679 $374 (S) APC 0690 $34.50 (S) APC 0690 $34.50 (S) APC 0690 $34.50 (S) APC 0690 $34.50 (S) % Change 6.9% 6.9% -1.6% -1.6% -1.6% -1.6% Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

63 APC CRDM National Payment Comparisons CPT Brief Description APC 2013 and SI Program device evaluation; dual lead ICD system Program device evaluation; multiple lead ICD system APC 0690 $33.95 (S) APC 0690 $33.95 (S) Program device evaluation; ILR APC 0690 $33.95 (S) APC 2012 and SI APC 0690 $34.50 (S) APC 0690 $34.50 (S) APC 0690 $34.50 (S) % Change -1.6% -1.6% -1.6% Peri-procedural device evaluation, pacer Status N Status N NA Peri-procedural device evaluation, ICD Status N Status N NA Interrogation device evaluation; all pacemaker systems Interrogation device evaluation; all ICD systems Interrogation device evaluation; implantable CV monitor (ICM) APC 0690 $33.95 (S) APC 0690 $33.95 (S) APC 0035 $23.43 (X) APC 0690 $34.50 (S) APC 0690 $34.50 (S) APC 0035 $18.81 (X) -1.6% -1.6% 24.4% Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

64 APC CRDM National Payment Comparisons CPT Brief Description APC 2013 and SI Interrogation device evaluation, ILR Interrogation; wearable ICD system Transtelephonic pacemaker evaluation(s), up to 90 days Interrogation device evaluation(s), up to 90 days; pacemaker system or ICD system Interrogation device evaluation(s), (remote), up to 30 days; ILR or ICM Echo, transthoracic, 2D, complete, with spectral and color flow Doppler APC 0690 $33.95 (S) APC 0690 $33.95 (S) APC 0690 $33.95 (S) APC 0690 $33.95 (S) APC 0690 $33.95 (S) APC 0269 $390 (S) APC 2012 and SI APC 0690 $34.50 (S) APC 0690 $34.50 (S) APC 0690 $34.50 (S) APC 0690 $34.50 (S) APC 0690 $34.50 (S) APC 0269 $393 (S) % Change -1.6% -1.6% -1.6% -1.6% -1.6% -0.8% Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

65 APC CRDM National Payment Comparisons CPT Brief Description APC 2013 and SI Echo, transthoracic, 2D, complete, w/o spectral and color flow Echo, transthoracic, 2D, follow-up or limited study APC 0269 $390 (S) APC 0697 $213 (S) Stress TTE APC 0269 $390 (S) Stress TTE complete APC 0270 $559 (S) Transseptal puncture APC 0080 $2,650 (T) Bundle of His recording APC 0084 $705 (S) APC 2012 and SI APC 0269 $393 (S) APC 0697 $221 (S) APC 0269 $393 (S) APC 0270 $580 (S) APC 0080 $2,721 (T) APC 0084 $695 (S) % Change -0.8% -3.6% -0.8% -3.6% -2.6% 1.4% Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

66 APC CRDM National Payment Comparisons CPT Brief Description APC 2013 and SI Intra-atrial recording APC 0084 $705 (S) Right ventricular recording APC 0084 $705 (S) Intra-atrial pacing APC 0084 $705 (S) Intraventricular pacing APC 0084 $705 (S) Esophageal pacing of atrial electrogram Esophageal pacing of atrial electrogram; w/recording APC 0084 $705 (S) APC 0084 $705 (S) APC 2012 and SI APC 0084 $695 (S) APC 0084 $695 (S) APC 0084 $695 (S) APC 0084 $695 (S) APC 0084 $695 (S) APC 0084 $695 (S) % Change 1.4% 1.4% 1.4% 1.4% 1.4% 1.4% Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

67 APC CRDM National Payment Comparisons CPT Brief Description APC 2013 and SI Induction of arrhythmia by electrical pacing Comprehensive EP study; without induction of arrhythmia Comprehensive EP study; with induction of arrhythmia EP follow-up study with pacing and recording to test effectiveness EP evaluation of single or dual chamber ICD Catheter ablation of AV node function APC 0084 $705 (S) APC 0085 $3,922 (T) APC 0085 $3,922 (T) APC 0085 $3,922 (T) APC 0084 $705 (S) APC 0085 $3,922 (T) APC 2012 and SI APC 0084 $695 (S) APC 0085 $3,762 (T) APC 0085 $3,762 (T) APC 0085 $3,762 (T) APC 0084 $695 (S) APC 0085 $3,762 (T) % Change 1.4% 4.2% 4.2% 4.2% 1.4% 4.2% Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY

68 APC CRDM National Payment Comparisons CPT Brief Description APC 2013 and SI Composite Composite Composite EPS, catheter ablation of SVT EPS, catheter ablation of VT EPS, catheter ablation of AF by PVI APC 8000 $11,146 (Q3) Tilt table evaluation APC 0101 $304 (S) Electronic analysis of antitachycardia pacemaker system APC 0690 $33.95 (S) Set up wearable ICD APC 0690 $33.95 (S) APC 2012 and SI APC 0086 $8,979 (T) APC 0086 $8,979 (T) APC 0086 $8,979 (T) APC 0101 $299 (S) APC 0690 $34.50 (S) APC 0690 $34.50 (S) % Change Comparison not valid as a result of new packaged ablation codes 1.7% -1.6% -1.6% Source: Addendum B. Final OPPS Payment by HCPCS Code for CY 2013 and CY