New Coronary Stenting Codes Add Up to Big Changes for Our Practices
October 31, 2012
This content is from the Fall 2012 issue of SCAI News & Highlights.
A Message From SCAI’s President and Advocacy Committee Chair
By J. Jeffrey Marshall, M.D., FSCAI, and James C. Blankenship, M.D., FSCAI
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.
Why New Codes?
In recent years, CMS has come under increasing pressure to identify any codes that could be mis-valued and re-value them based on prevailing, modern-day practice realities. Diagnostic imaging services were among those targeted in 2008, when nuclear cardiology and echocardiography suffered decreases of 10–40 percent. In 2010, CMS suggested that diagnostic catheterization codes should be devalued by 20–30 percent; SCAI, in partnership with the ACC, fought CMS and succeeded in limiting the reduction to 10 percent.
When CMS fast-tracked coronary stenting services for re-valuation last year, SCAI teamed up with the ACC to propose a new payment paradigm that would appropriately value both the simple and the complex coronary stenting procedures. By agreeing that coronary stenting had not be re-examined in the past 17 years and showing how much stenting has advanced since then, we successfully demonstrated that complex coronary stenting has in fact been undervalued for years.
Since 1994, there have been only two CPT® codes for coronary – 92980 for stenting the first artery and 92981 for stenting an additional artery. SCAI representative Arthur C. Lee, M.D., FSCAI, and ACC representative Robert Piana, M.D., successfully argued the limitations of this coding model, and then they developed an entirely new CPT coding structure with new codes that will support reimbursement for treating the sidebranches and for more complex interventions involving bypass grafts, chronic total occlusions, or ST-elevation myocardial infarction. Clifford Kavinsky, M.D., Ph.D., FSCAI, and Dr. Piana then presented these codes to the AMA Relative Value Update Committee (RUC) and succeeded in convincing RUC members to adopt our estimated values for the new PCI codes. The RUC formally recommended that CMS adopt these values for the new PCI codes starting in 2013.
What Happens Now?
In early November 2012, CMS will publish the RVU values for the new PCI codes. The new codes and their values will go into effect Jan. 1, 2013.
What Can You Do Now?
As soon as the final Medicare fee schedule is published, all interventional cardiologists who care for Medicare beneficiaries will have an important task to accomplish.
First, each of us needs to learn the new codes and help our coding staff to master them. SCAI and ACC will roll out a series of tools to help with this process, starting with a webinar conducted by the physicians who developed the codes and defended them to CMS and RUC.
Second, we need to look to the future. This year, we succeeded in obtaining more appropriate reimbursement for complex coronary interventions, thereby mitigating the overall impact of cuts for simple stenting scenarios. Your support and engagement in SCAI makes efforts like this successful. So, please get involved with SCAI today!
And, finally, be aware that SCAI is actively working to create pathways for reimbursement of newer interventional procedures. When a new code is secured, it must be championed through the RUC process. You can support this process by completing RUC surveys when they are sent to you.
Please send your comments and questions about the new codes or other advocacy issues directly to president@SCAI.org. To discuss how you can get involved in SCAI’s Advocacy Committee, email Wayne Powell at wpowell@SCAI.org. To learn more about all of SCAI’s committees, click here, or email info@SCAI.org.