Cardiology Coding Alert

Rumor had it that vascular closure devices would be unbundled from cardiac catheterizations after November, 1998, thus allowing for separate, and higher, reimbursement.

Is it true? Unfortunately, expert sources say, no.

The hearsay gained momentum when the Coding and Nomenclature Committee of the American College Cardiology (ACC) met in November 1998 to discuss the issue.

But ACC sources tell us that, after checking with the cardiac cath committee, the group agreed that vascular access site hemostatis by any technique -- manual or mechanical -- remains an integral part of the cath and does not warrant a separate code.

The committee is, however, open to reviewing additional information and will consider proposals to address this matter further.

The CPT Advisory Committee for the American Medical Association is also currently reviewing a proposal for a specific procedural code by a mechanical device manufacturer, says ACCs advisory committee member James C. Blankenship, MD, FACC.

Does New Technology Help or Hurt
Reimbursement?

The most uncomfortable parts of the catheterization procedure for patients is the immobility required and the nurses intense direct pressure at the site close the arterial access.

But with a vascular closure device, femoral artery punctures can be quickly and effectively closed without as much post-procedure discomfort.

Such technology could also allow many current inpatient procedures to be performed on an outpatient basis.

Yet Susan Stradley, CPC, CCS-P, points out that while the device may make life easier for the patient, it does not necessarily make reimbursement higher for the physician, says the senior consultant for Medical Group of Elliott Davis and Co., LLP, headquartered in Greenville, SC.

Heres why: The way most payers consider the repair of the femoral artery after a catheterization, is that the physician created the puncture in order to do the procedure, so its up to him or her to repair it as part of that procedure. They dont consider which method is more comfortable for the patient, she explains.

If using the new technology adds significantly more work for the physician, or significantly increases the risk for the patient, Stradley explains. In the case of vascular closure devices, neither is the case, she adds.

Tips for Reimbursement

But there still may be a slight chance of getting reimbursed from some payers, Stradley says.

Make phone calls to your five largest insurance carriers and ask them if they consider the device to be consistently bundled, or if they will [...]