A bipartisan fiscal cliff deal has averted dramatic 27 percent across-the-board cuts for all Medicare procedures by "patching" the Sustainable Growth Rate (SGR) for another year. However, fee schedule changes for 2013 (including cuts in PCI procedures) will however go into effect. Additionaly, possible cuts of about 2% due to sequestration are have only been delayed by two months; SCAI expects no certainty about those cuts until at least the end of February.

Yesterday the Centers for Medicare & Medicaid Services (CMS) released the final 2013 Medicare Physician Fee Schedule announcing payment rates for the services we and other doctors provide to Medicare beneficiaries. In the bullets below, we discuss several of the key decisions relevant to the practice of Interventional Cardiology, but the over-riding message we wish to share with you, SCAI’s members, is this: In an overt effort to transfer funds from the payment of specialty procedures to primary care, CMS has targeted established procedures for bundling and revaluation, with the assumption that bundled services include economies and support lower values. CMS has increasingly ignored the coding and valuation recommendations developed through the AMA’s CPT and RUC processes. Now, in an unprecedented move, CMS is rejecting many of the new codes developed for PCI and announcing 19%-28% reductions in the base codes for stenting procedures. We are closely examining the calculations CMS made to ensure no errors were introduced and that related practice expense and malpractice values were captured with the bundled codes.

Sweeping changes are coming for interventional cardiology coding in 2013. For starters, SCAI was successful in securing Category I codes for percutaneous ventricular assist procedures (pVAD) (33990–33993) and transcatheter aortic valve repair (TAVR) (33361–33365). In addition, there are new codes for diagnostic cervico-cerebral angiography (36221–36228) and non-coronary thrombolysis (37211–37214). But the most significant change for 2013 is the complete restructuring of the codes and coding conventions for reporting percutaneous coronary interventions (PCI).

Following publicity around FAME 2, many cardiologists and their coding staff may have questions about reimbursement for fractional flow reserve (FFR). SCAI fought for add-on payments for the use of FFR technology, succeeding in obtaining CPT® code 93571 and the additional payment average allowed charge of $91 but not in getting additional payments for hospitals. Although SCAI leveraged the support of a CMS-convened hospital payment advisory board, the agency continues to say FFR is a bundled procedure included in the facility's inpatient and outpatient payment rates.

Can renal PTA (percutaneous transluminal angioplasty) be reported in conjunction with renal stent placement? Is preceding diagnostic angiography additionally reportable?