Cardiology Coding Alert

See which new codes national Medicare didn’t set payment for.

The Medicare Physician Fee Schedule (MPFS) for 2014 revealed disappointing news for new Internet/phone consult codes and aorta repair using fenestrated grafts. See how other new codes fared.

Medicare Nixes Payment for These Codes

Consults: Many coders were interested to see CPT^® introduce codes for consults by Internet or telephone. You report the code when your cardiologist supplies a consult requested by another provider.

MPFS 2014 shows that Medicare gives a status B to these codes: 99446-99449 (Interprofessional telephone/Internet assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional …).

Status B means Medicare doesn’t pay separately for these codes. Instead, payment is always bundled into other services. Consequently, there are no relative value units (RVUs) assigned to these codes in MPFS 2014.

Fenestrated aorta repair: Your local MAC will have discretion over whether to cover 2014’s new codes for endovascular aorta repair using a fenestrated endograft. The codes below have status C and also don’t have RVUs assigned:

• 34841-34844, Endovascular repair of visceral aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) by deployment of a fenestrated visceral aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed …
• 34845-34848, Endovascular repair of visceral aorta and infrarenal abdominal aorta (e.g., aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption) with a fenestrated visceral aortic endograft and concomitant unibody or modular infrarenal aortic endograft and all associated radiological supervision and interpretation, including target zone angioplasty, when performed …

Take These RVU Totals Into Account for 2014

Several other new cardiology codes are status A (Active code), and do have RVUs assigned. The table below shows the non-facility RVU totals (for services performed in your office) and facility RVU totals (for services your physician performs at a hospital).

The total includes Work RVUs, Non-Facility or Facility Practice Expense RVUs, and Malpractice RVUs. The final reimbursement amount is determined by multiplying the total RVUs by the conversion factor, which changes year to year. The 2013 conversion factor was 34.023. The conversion factor originally given for MPFS 2014 was 27.2006, but the expectation was that lawmakers would step in to prevent this steep cut as they have for the past several years. The conversion factor for 2014 was changed to $35.8228, according to CMS’s Dec. 27, 2013, announcement, “President Obama Signs the Pathway for SGR Reform Act of 2013.” The geographic practice cost index (GPCI) also affects the final fee for a particular locality.