CMS Fee Schedule Changes for Cardiology Procedure

As we approach 2013 CMS has announced major changes to many highly used CPT codes relating to cardiology procedure.  These code changes cover coronary interventions and electrophysiology.  Physicians and coders need to be aware of these changes prior to the new year.

In the past when performing a coronary intervention a physician could only bill for one procedure per artery even though there may be multiple lesions in that vessel that require an intervention.  With the new codes a physician can bill for multiple procedure in the same artery or bypass graph.   There are also new codes for interventions in the branches of an artery.   Sounds like a positive move but, CMS has these labeled these as status B bundled so for now the new codes will be billed but denied for payment by Medicare.  Commercials may still pay on these codes but in a recent fee schedule negotiation with United Healthcare they did not have the new codes and currently have their fee schedule staff looking into the CPT changes and pricing.  Most old PCI codes have been deleted so attention to these changes is critical in January.

Electrophysiology procedures have also seen significant changes and they include more bundling.  EPS and SVT ablation and EPS and VT ablations have both been bundled.  There are also new A Fib ablations codes with primary and add on for Atrial Fibrillation Ablations.  An example would be a physician performs an A Fib ablation and the patient now has an A Fib Flutter.  If the physician ablates another location to address the flutter the CPT add on code 93655 can be used. Use of an add on codes will require additional supporting documentation.

The other change you will see relating to many CPT codes are reduced RVU values.  So for physicians with an RVU driven compensation model there may be a reduction in compensation for 2013.  The above examples are just a sampling of the many changes coming relating to the cardiology CPT codes.  Spend the time now to research the impact of these changes and make sure both physicians and their billing staff understand when to use these new codes and the proper documentation in the procedure note to support their use.