Cardiology Coding Alert


Check CMS Manuals for G0166 Details

Question: I've heard that payment for ECP is decreasing in 2010. Where can I find more information on G0166?

California Subscriber

Answer: Check out the Medicare Claims Processing Manual, Chapter 32, Section 130, and the Medicare National Coverage Determinations Manual, Chapter 1, Section 20.20, for more information on G0166 (External counterpulsation, per treatment session).

RVUs: The drop in relative value units (RVUs) isn't too substantial, changing from 4.16 in 2009 to 4.03 in 2010.

ECP: The manuals explain that ECP is a non-invasive treatment for coronary artery disease. Medicare covers the service for patients with stable angina if the cardiologist decides they aren't good surgery candidates. CMS has a specific list of reasons patients aren't amenable to surgery, such as having an inoperable condition or risk-creating comorbidities.

You'll find a long list of codes you shouldn't report alongside G0166 unless you can prove they were separate and distinct. These include (among others):

• 92971 (Cardioassist-method of circulatory assist;external)

• monitoring tests such as 93040-93041 (Rhythm ECG, 1-3 leads ...)

• E/M codes such as 99201-99215 (Office or other outpatient visit ...)

"A full course of therapy usually consists of 35 one-hour treatments which may be offered once or twice daily,usually 5 days per week," the NCD manual states.

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