• CLINICAL INTEREST SECTIONS: Coronary Peripheral TAVR Center

  • SCAI This Week
  • September 7, 2012

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    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).

    The new family of PCI codes represents a significant departure from existing coding conventions for these services. There are two subsets of codes:

    • The first eight codes were patterned after the coding conventions established for new lower limb revascularization codes, which went into effect in 2011. These codes support reporting revascularization for each major coronary artery(ies) and branch(es) treated. The major coronary arteries are now identified as the left main, left anterior descending, left circumflex, right, and ramus intermedius arteries. All revascularization procedures performed in all segments (proximal, mid, distal) of a single major coronary artery through the native coronary circulation are reported with one code.
    • The final five codes define these same services when provided to certain specific patient populations – those who have had coronary artery bypass graft(s) (CABG), those having active ST-elevated myocardial infarction (STEMI), and those with chronic total coronary artery occlusion.  

    SCAI is gearing up to educate and prepare you and your staff for these sweeping coding changes coming in 2013.

    SAVE THE DATE - November 28, 2012, from 3-5 PM (ET)
    2013 Coding Update from the House of CardiologySCAI, ACC, and HRS Are Coming Together to Prepare You for the Sweeping Changes in Cardiology Coding Coming in 2013

    Mark your office calendars now for a web-based educational program designed to prepare you and your billing staff for major changes coming to cardiology coding in 2013. To protect the valuations for your bread-and-butter procedures, the House of Cardiology initiated a complete restructuring of the codes and coding conventions for percutaneous coronary interventions (PCI) and ablation procedures.

    At this important webinar, you will learn directly from those who presented the codes and sat at the table during the CPT and RUC processes. Learn from experts Robert Piana, MD, FACC, Amit J. Shanker, MD, FHRS, Art Lee, MD, FSCAI, and Clifford Kavinsky, MD, PhD, FSCAI, how to code for these procedures using the new coding paradigms.

    And don't miss this opportunity to hear from James Blankenship, MD, FACC, FSCAI, who serves as Cardiology's RUC Panel representative and will present the spotlight topic: "The RUC Process, the RUC Survey and the Benefits of Coalition Building." Dr. Blankenship will describe and take your questions about the impact of the RUC on you and your practice, why your participation in the process is essential, and how SCAI, ACC and HRS band together and engage others in efforts to protect the values for the services and procedures provided to cardiovascular patients.

    More Information on AMA's CPT® 2013 Data File

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    Lessons from the Department of Justice's Investigation of ICD Implants

    Last Friday Modern Healthcare reported many hospitals across the United States have received letters from the Department of Justice (DOJ) about their implantation of ICDs . The letters reportedly asked facilities to assess their compliance with that national coverage policy and assess their liability for non-compliance.  Importantly, the DOJ’s focus is not on medical necessity; it is on compliance with the national coverage policy. 

    The expectation is that many hospitals will be fined for implanting devices outside the parameters of the coverage decision. Lower fines and penalties may be applied to procedures considered medically necessary but not covered, and some procedures performed outside of specified time periods may not be penalized at all. It is likely that the harshest penalties will be applied to procedures that were not covered and also considered to be not medically necessary.  SCAI believes the implication of these letters is that hospitals would do better to self-assess any wrongdoing now and settle with the government before the government further investigates, potentially levying heavier fines.

    The take-away for interventional cardiologists and their facilities is to ensure their practices are complying with the two major national coverage decisions applicable to procedures they may perform:

    1. The national coverage policy on carotid artery stenting; and
    2. The new coverage policy on TAVR procedures

    All participating providers in the Medicare program are legally bound to know the coverage policies before submitting claims.  Ignorance of the policies is not considered to be a valid defense. 
     
    A false claim is a submission for a procedure that one knew, or should have known, was not covered.  When a provider knows a procedure is not covered under a national policy, then it may be billed to the patient directly as long as the patient has signed an appropriate Advance Beneficiary Notice.  For information on how to use the Advance Beneficiary notices, see SCAI's recent Coding Q&A article, “What to Do When Patients Request Procedures Medicare Doesn’t Cover”.  

    It is important to note that Medicare beneficiaries have the right to appeal national coverage policies and may receive coverage in this manner, but providers may not appeal coverage policies.

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    SCAI President Quoted on Stent Controversy

    SCAI President J. Jeffrey Marshall, MD, FSCAI, is extensively quoted in a just-published column on HealthLeadersMedia.com, a news outlet for healthcare executives that reaches 200,000 subscribers. Columnist Joe Cantlupe reviews the recent controversies around stenting, citing the New York Times investigation of HCA hospitals as well as data from the COURAGE trial. Dr. Marshall's voice is heard throughout the article, pointing out, for example, SCAI's work in cath lab accreditation through Accreditation for Cardiovascular Excellence (ACE) and its efforts to encourage participation in data registries (a key recommendation in SCAI-QIT). The results of the recently published FAME 2 trial are highlighted, as are the benefits of PCI for treatment of heart attack and improvement of quality of life.

    Read the Article

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    Trial Watch: PROTECT II Provides Hope for High-Risk PCI Patients

    PROTECT II Study of PCI With Hemodynamic Support Shows Evidence of Sustained Benefit

    by Srihari S. Naidu, MD, FSCAI

    Patients with severely reduced ejection fraction (<30-35%) and significant areas of ischemia or infarction, represented by multi-vessel coronary artery disease, left main disease or last patent conduit disease, are considered the highest risk population for PCI. Traditionally referred to coronary artery bypass grafting (CABG), these patients are often deemed too high risk or ineligible for surgery. In such cases, high-risk PCI or continued medical therapy remain the only viable options.

    Historically, these patients are considered for PCI with adjunct mechanical hemodynamic support devices to mitigate the risk of peri-procedural decompensation and death. However, the benefit of such an approach has always been questioned. Previous trials randomized patients to hemodynamic support versus no hemodynamic support raising concerns that lower risk patients were being recruited than in real-world high-risk PCI.

    Structured as a randomized controlled trial of mechanical support in high-risk PCI, PROTECT II enrolled 452 patients and randomized them to either the Impella 2.5 (n=226) device or intra-aortic balloon counterpulsation (IABP, n=226). This very high-risk cohort included the following:  mean ejection fraction of 24%, mean SYNTAX score of 30, and high proportions of diabetes and Class III/IV heart failure (51% and 66%, respectively). The prevalence of renal failure, peripheral vascular disease, prior CABG, stroke, and inoperability in these patients was also among the highest of any PCI trial to date.

    PCI with hemodynamic support was safe and feasible despite these high-risk features. The primary endpoint, a combination of roughly 10 major adverse events at 30 days, was not statistically different between groups (Impella 35.1% vs. IABP 40.1%, p=0.227). At 90 days, there remained no statistical difference in outcome, but a trend toward fewer major adverse events with use of the Impella (40.6% vs. 49.3%, p=0.066). However, Impella 2.5 provided superior hemodynamic support, as demonstrated by less diminution of cardiac power output during the procedure (Impella 0.04 vs. IABP 0.14 Watts, p=0.001), a secondary endpoint of the trial.   

    Most importantly, and regardless of support type, revascularization was successful overall, with a 30-day mortality of approximately 6% in this very high-risk population. It is noteworthy that the STS score was also 6% with an expected surgical mortality potentially even higher since these patients were selected as non-surgical candidates. Finally, by 90 days, ejection fraction improved in the overall patient population (27% vs. 33%, p<0.001), with an approximate 60% reduction in the prevalence of clinically significant Class III/IV heart failure s noted (62% vs. 26%, p<0.001); these findings are unique  in the PCI literature.

    Taken together, patients with severely reduced ejection fraction and large amounts of ischemia or infarction, as represented by the anatomic inclusion criteria, in which the operator believes hemodynamic support is required, can be safely revascularized using available hemodynamic support devices. Robust improvements in ejection fraction and heart failure class were evident within 90 days, validating such an approach.

    So, let’s not give up on those high-risk PCI patients. They may have the highest risk for clinical decompensation or death of all the patients we treat, but PROTECT II shows they can be performed safely with a high degree of success (both procedurally and clinically at 3 months) when combined with a strategy of routine mechanical support deemed necessary by the operator.

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    eLearning Spotlight: SCAI 2012 On Demand Features Session on FFR

    After the recent release of FAME II data are you looking for a focused online learning opportunity on FFR?

    SCAI 2012 On Demand makes it easy featuring content from the session, Maximizing PCI Outcomes: Lesion Assessment (FFR, IVUS and OCT).

    Better yet, SCAI 2012 On Demand also features focused content on other hot topics such as TAVR, CTO, CLI and TRI allowing users to immerse themselves in all of these topics and more, bringing you multimedia re-creations with audio synchronized with slides which can be viewed from your PC or laptop or on your iPhone or iPad while you are on the go. This includes programming from SCAI 2012's Transradial Mini-symposia, CTO Mini-symposium, TAVR Mini-symposiam, CLI Symposium, Hemodynamics Symposium, and more!

    Starting at just $249 for non-attendee members, SCAI 2012 On Demand content will be available through May 1, 2013.

    Purchase SCAI 2012 On Demand Now!

    * SCAI cannot guarantee 100% of sessions will be made available in SCAI 2012 On Demand

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    Dr. Jennifer Tremmel on Why YOU Should Apply for ELM Fellowship

    SCAI's Emerging Leader Mentorship (ELM) Program in formal partnership with ACC and CRF is now accepting applications for the next wave of interventional/invasive cardiology leaders during its 2013-15 cycle.

    The ELM Program is charged with finding a small, highly selective group of up-and-coming physicians (there are 10 openings for the 2013-2015 cycle) and facilitating their transition into the next generation of great thinkers, presenters, teachers and national leaders.

    ELM Fellows participate in six training sessions over a two year period, timed with the SCAI, TCT and ACC annual conferences, and will be assigned a mentor specifically chosen to match their interests and aspirations. Satellite sessions will explore other topics, such as dedicated leadership skill training and the role of industry. 

    They will also be encouraged to, and assisted in, identifying opportunities for committee service and faculty assignment with committee/program chairs at SCAI and partnering organizations. Identifying those opportunities congruent with their interests and developing niches, as well as opportunities to develop their own ideas and projects, will be a core goal of the ELM Program. Their progress over the two-year period will be tracked actively by the Program Committee to assure autonomous future success.

    However, don't just take our word for it. Click on the above image to hear how ELM has helped open doors for Jennifer A. Tremmel, MD, FSCAI.

    Apply Today - The Application Deadline is November 15, 2012!

    Learn More about the ELM Program

    Follow the 2011-2013 ELM Fellows' Accomplishments!

    Find Out How All ELM Fellowship Applicants Benefit

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