CMS Rescinds “One Intervention per Vessel” Rule

The Centers for Medicare and Medicaid Services (CMS) has rescinded a controversial change to national Correct Coding Initiative (CCI) guidelines that limited physicians to coding for a single intervention per vessel, regardless of the number of interventions they actually performed.
Added language in Chapter 5, Section D of CCI Version 13.3 (Oct. 1 2007) instructed:

If an atherectomy fails to adequately improve blood flow and is followed by an angioplasty at the same site/vessel during the same patient encounter, only the successful angioplasty may be reported. Similarly if an angioplasty fails to adequately improve blood flow and is followed by an atherectomy at the same site/vessel at the same patient encounter, only the successful atherectomy may be reported. If atherectomy and/or angioplasty fail to adequately improve blood flow and are followed by a stenting procedure at the same site/vessel during the same patient encounter, only the successful stenting procedure may be reported. These principles apply to percutaneous or open procedures.

For example, if a patient underwent an unsuccessful angioplasty (35474 Transluminal balloon angioplasty, percutaneous; femoral-popliteal) followed by a successful stenting of the same vessel (37205 Transcatheter placement of an intravascular stent[s] [except coronary, carotid and vertebral vessel], percutaneous; initial vessel), you would report only the stent, 37205.
Prior to the change in CCI language last year, you could report multiple interventions (angioplasty, atherectomy, stenting) in the same vessel separately if the procedure met certain requirements.
Physicians and physician advocacy groups protested the revised guidelines, pointing out that allowing physicians to report only a “successful” stent would mean that, in many cases, a physician would perform the work of two procedures (such as percutaneous transluminal angioplasty and stenting) but would receive payment only for the lesser-valued procedure.
CMS has by reinstating the pre-version 13.3 CCI guidelines, which instruct, “When percutaneous angioplasty of a vascular lesion is followed at the same session by a percutaneous or open atherectomy, generally due to insufficient improvement in vascular flow with angioplasty alone, only the most comprehensive atherectomy that was performed (generally the open procedure) is reported.”
The latest revision appears in version 14.3 of the CCI, which became effective Oct. 1.
Take action: The latest CCI change will be retroactive to Oct. 1, 2007. Those practices that filed correctly under CCI 13.3 guidelines can now re-file those claims to recoup compensation lost to the “one intervention per vessel” rule.

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