• Featured Article

    General Advocacy

    Society Requests CIGNA to Extend Patient Access to pVAD Devices

    Late last week SCAI submitted a request to CIGNA to update and revise its medical coverage policy on ventricular assist Devices (VADs) and percutaneous cardiac support systems (coverage policy 0054).
  • Coding & Reimbursement Issues

    January 03, 2013

    SCAI Cautions CMS on Negative Consequences of 2013 MPFS Final Rule

    In its final advocacy efforts of 2012, SCAI submitted harsh comments to CMS regarding the 2013 Medicare Physician Fee Schedule Final Rule, cautioning CMS about the potential unintended consequences resulting from the continued erosion of values for interventional cardiology procedures.
    January 03, 2013

    Fiscal Cliff Deal Averts 27% SGR Cuts, But Other Cuts Will Impact Interventional Cardiology

    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.
    December 17, 2012

    Society Requests CIGNA to Extend Patient Access to pVAD Devices

    Late last week SCAI submitted a request to CIGNA to update and revise its medical coverage policy on ventricular assist Devices (VADs) and percutaneous cardiac support systems (coverage policy 0054).
    November 02, 2012

    Urgent Message About 2013 Medicare Physician Fee Schedule

    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.
    October 31, 2012

    New Coronary Stenting Codes Add Up to Big Changes for Our Practices

    On Jan. 1, 2013, the Centers for Medicare and Medicaid Services (CMS) wil l begin using new codes for reimbursement of coronary stenting procedures. The new codes will differentiate between simple and complex stenting scenarios, likely reducing fees for the former for the first time since 1994 while, also for the first time, reimbursing the latter at higher levels. The task for interventional cardiologists and their coding staff is to master the new codes in order to ensure appropriate reimbursement for their practices. SCAI, in partnership with the American College of Cardiology (ACC), will be offering many tools to help.
    October 31, 2012

    Sweeping Changes Coming for Interventional Cardiology 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).
    September 07, 2012

    New Interventional Cardiology Codes for 2013 Released

    The AMA released the CPT ®2013 Data File this week, providing the public’s first glimpse at the new code numbers and descriptors for 2013. There are many new codes for interventional cardiology, including a new family of 13 codes describing PCI procedures (92920-92944), a new family of codes to describe transcatheter aortic valve repair (TAVR) from a endovascular approach (33361-33365) and four new codes describing the insertion, repositioning, and removal of percutaneous ventricular assist devices (pVADs) (33990-33993).
    August 31, 2012

    FFR & Reimbursement: What Cardiologists & Coders Should Know

    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.
    June 01, 2012

    Coding Q&A: Coding for Renal PTA/Stenting and Dx Renal Angiography: Clear Documentation Essential

    Can renal PTA (percutaneous transluminal angioplasty) be reported in conjunction with renal stent placement? Is preceding diagnostic angiography additionally reportable?
    March 01, 2012

    Coding Q&A: What to Do When Patients Request Procedures Medicare Doesn’t Cover

    Medicare seems to be issuing more and more restrictive coverage policies. What if my patient demands access to a procedure for indications not supported by Medicare and is willing to pay directly for these services? Can I bill my patient, or would this violate my Medicare participation agreement?