Cardiology Coding Alert
Fee Schedule Shows Diagnostic Procedure Reductions
Under the 2003 fee schedule, which CMS published in the Dec. 31, 2002, Federal Register, cardiologists will fare slightly better than their peers in other specialties, but they may see less money from their Medicare carriers than in 2002. The good news is that reimbursement reductions for nuclear studies, Doppler and color-flow procedures, and stress tests are below the 4 percent mark, and T-wave alternans reimbursement rose by 50 percent, Collins says. Hang on to Claims for New Codes CPT 2003 introduces six new cardiology codes, including three new biventricular device implantation and lead repositioning codes. The American College of Cardiology (ACC) helped to determine appropriate payment for these codes through the American Medical Association's Relative Update Committee (RUC), says Anne Bicha, with the ACC's regulatory and legal affairs department. The biventricular codes received adequate, although not extravagant, RVUs, according to coding analysts. It is expected that the RVUs for these codes will be similar to the RVUs for 92982 (Percutaneous transluminal coronary angioplasty; single vessel), which are 16.16, says Barbara Veath, senior reimbursement manager for heart failure products with Medtronic Inc. in Minneapolis. Low Reimbursement for G Codes CMS now requires that you code renal and iliac angiography performed at the time of cardiac catheterization using two new G codes:
CMS assigns total RVUs of 0.36 for both G0275 and G0278, which coders see as inadequate for the work involved. Cardiologists who perform peripheral vascular diagnostic tests during heart catheterizations are going to receive about $12 for these tests now, Collins says. "You get paid more for irrigating somebody's ear than for doing a bilateral selective renal angiography on them," he says. Coders should consult with local carriers to verify edits and coverage, coding consultants advise.
Although the overall Medicare payment rates will decrease by 4.4 percent on March 1, cardiology practices should look for decreases in the 3 to 3.5 percent range, depending on their utilization profiles, says Jim Collins, CHCC, CPC, president of Compliant MD Inc. in Matthews, N.C., and compliance manager for Mid Carolina Cardiology in Charlotte, N.C.
CMS also cut the relative value unit (RVU) conversion rate from $36.1992 in 2002 to $34.5920 in 2003.
CMS advises that the RVUs for the new codes are interim RVUs and that it will consider comments on these until March 3.
Even so, reimbursement for these codes could offset decreases for other procedures in practices where biventricular device implantation is becoming common, coding experts say. (See "Interim RVUs for New CPT Codes" to the right for new code descriptions and assigned RVUs.)
Many carriers are encouraging physicians not to report the new or modified codes until after the Fee Schedule goes into effect, Collins says. "However, if you report the new codes before March 1, the entire claim will be suspended in the carrier's system, and the carrier will be forced to pay you 5.5 percent annual-percentage-rate interest on the entire claim amount after a 30-day, 'prompt-pay'period has elapsed," he says.
The interest will earn you a little extra money and help you avoid the administrative burden of placing claims on hold and billing them in two months, Collins says.
The ACC is developing a response to CMS regarding reimbursement for these G codes, according to a statement on the organization's Web site.
Note: For more on the Physician Fee Schedule , go to ACC's Web site: http://www.acc.org/advocacy/advoc_issues/rc_medicaresummary010603.htm.
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