SCAI Efforts Lead to Adjusted Reimbursement for AAA Endovascular Grafts
August 03, 2012
CMS released the Final Rule for the 2013 Inpatient Prospective Payment System (IPPS) on Wednesday.
Following recommendations by SCAI in comments regarding the proposed IPPS rule, CMS has reassigned the fenestrated graft abdominal aortic aneurysm (AAA) endovascular repair code to a more appropriate DRG assignment, aligning hospital payment for these services with other endovascular graft procedures.
"This is a real victory for patients. When hospitals are properly reimbursed for a procedure this allows new technologies, and patient access to them, to thrive," said Kamal Gupta, MD, FSCAI, associate professor in the division of cardiovascular diseases at University of Kansas Medical Center in Kansas City, KS.
Dr. Gupta said this decision by CMS comes at an opportune time.
"Fenestrated grafts have been in limited clinical use (mostly under the purview of clinical studies) for about a decade or more. However, they have an important role in treating patients with para-renal and also for thoraco-abdominal aortic aneurysms, especially those with significant co-morbidities. Newer fenestrated grafts are being developed and even 'off the shelf' devices may be available in the future," said Dr. Gupta, who is amongst approximately 10% of interventional cardiologists who perform AAA endovascular repairs. Click on the video above to hear more from Dr. Gupta on this topic.
Regretfully, CMS did not heed SCAI's recommendation to reassign the mitral valve procedure code to more applicable valve procedure DRGs, electing to retain the mitral valve procedure code within DRGs includprocedures such as balloon valvuloplasty and percutaneous transluminal coronary angioplasty (PTCA).
SCAI believes these procedures are not similar in regards to intensity and resulting resource consumption and will continue to provide educational materials and guidance to CMS regarding the appropriate DRG assignment for transcatheter mitral valve procedures.