Coding Alerts

SIR Strongly Urges Members to Participate in the AMA Multi-Specialty Practice Expense Survey

SIR Members to be selected at random- if called, your participation is critical. Please read the following announcement from the AMA regarding this important initiative.

From the AMA:

Watch your mail for Physician Practice Information survey. The AMA and more than 70 other organizations are conducting a comprehensive multi-specialty survey of America’s physician practices. The results will be used to positively influence national decision makers to ensure accurate and fair representation for all physicians and patients, and to articulate the challenges of running a practice that provides expert patient care, while operating a business that is sustainable. Of particular importance is the section of the study pertaining to practice expenses and the amounts that are attributable to you. The Centers for Medicare & Medicaid Services has indicated it will use the results of this study to help determine physician payment. The survey firm, Dmrkynetec, will contact randomly selected physicians and practice managers to collect responses. Please encourage your staff to make this information available, as the survey’s success depends on accurate and complete data. All responses will remain confidential.

SIR Secures 2008 Medicare Reimbursement Rates for Freestanding IR Stent Services

(Posted 7/20/07; Revised 11/8/07)

SIR's initiative to secure freestanding/non-facility RVU rates for IR stent services has met with success. The final rule for the 2008 Medicare Physician Fee Schedule (MPFS) went on display on November 1, 2007 and includes non-facility RVU rates for IR stent services. The non-facility RVU rates for stent codes 37205, 37206, and 76960 are 108.64, 66.45, and 2.71 RVUs, respectively. SIR was successful in contesting CMS' initial proposal to only include the cost of one stent in the non-facility practice expense (PE) RVU rate for code 37205 with CMS electing to include the cost of 1.5 stents in the final rule, as proposed by SIR. Additionally, in response to manufacturers opposing the creation of non-facility rates for these services, CMS referenced the literature SIR submitted, supporting safety of these procedures with short-term recovery times as is common in the freestanding setting. Dr. Gerald Niedzwiecki, supported by Drs. Robert Vogelzang and Sean Tutton, presented SIR's request to establish non-facility practice expense inputs for the IR stent codes at the April 2007 RUC-PERC meeting.

The 2008 Medicare Physician Fee Schedule RVU file is now available for download via the CMS Web site.

2008 HOPPS Final Rule Released – UFE Garners New APC Assignment, CMS Bundles RS&I

(Posted 11/8/07)

On November 1, 2007, the Centers for Medicare and Medicaid Services (CMS) issued the 2008 Hospital Outpatient Prospective Payment System (HOPPS) final rule containing both good and bad news for IR outpatient hospital departments.

The final rule finds that SIR was successful in garnering a change in the Ambulatory Payment Classification (APC) for the uterine fibroid embolization code 37210, from APC 0202 to APC 0229. APC 0229 includes image guided, device-intensive procedures similar to UFE. The previous assignment was to APC 0202, which has a 2008 national average reimbursement rate of only $2720.36. APC 0229 has a 2008 national average reimbursement rate of $5639, representing a significant increase in reimbursement for UFE when provided in the outpatient setting.

However, despite strong opposition from SIR and against the advice of the APC Advisory Panel, CMS elected to move forward with bundling RS&I and many imaging guidance codes (not already bundled) under the Hospital Outpatient Prospective Payment System (HOPPS). CMS did make some adjustments to their initial proposal to address some of the concerns raised, but hospital outpatient departments should expect to see reductions in reimbursement particularly for many IR cardiovascular services.

NEW INTERVENTIONAL RADIOLOGY CODES FOR 2007

(Posted 1/4/07)

CPT 2007 contains many new, revised and renumbered interventional radiology codes. The AMA CPT Editorial Panel supported by the CPT Advisory Committee is responsible for maintaining CPT®. Advisory Committee membership is limited to those national medical societies seated in the AMA House of Delegates.

Katharine Krol, MD currently serves on the CPT Advisory Committee as SIR’s CPT Advisor, overseeing CPT activities for SIR; supported by members of the SIR Economics Committee.

SIR was instrumental in sponsoring and/or supporting CPT code applications resulting in the creation of, and revision to, codes for the following services:

Category I Codes

Category III Codes

Additionally, in an effort to promote greater consistency within CPT, several interventional radiology imaging codes were revised and many were renumbered.

Finally, CMS issued two new G-codes (Level II HCPCS codes issued by CMS to report services within the Medicare system) to report A-V fistula PTA services.

There may be additional new and revised codes in CPT 2007 pertaining to interventional radiology services; the discussion of the codes presented is not comprehensive, and does not replace CPT, copies of which can be purchased via the AMA.

Due to various factors complicating the calculations for physician reimbursement under the Medicare Physician Fee Schedule, such as the DRA (Deficit Reduction Act) cap to non-facility imaging services reimbursement rates, revision to the practice expense calculation methodology, impact of the Five-Year Review, CMS has released several versions of the 2007 Medicare Physician Fee Schedule, which details the RVU amounts and global periods established for these new codes. For the most update to date version, visit the CMS Web site.

NOTE: RVUs amounts presented are the most current available at the time this document was written, which was the version of the 2007 Medicare Physician Fee Schedule RVU file issued by CMS on 12/20/2006 and may be subject to change.

SIR assumes no liability, legal, financial or otherwise, for physicians or other entities who utilize this information in a manner inconsistent with the coverage and payment policies of any payers or Medicare contractors to which the physician or other entity has submitted claims for the reimbursement of services performed by the physician. CPT® codes and their descriptors are copyright 2005 by the American Medical Association.

NEW INTERVENTIONAL RADIOLOGY CODES FOR 2006

(posted 12/12/05)

CPT 2006 contains many new and revised interventional radiology codes. The AMA CPT Editorial Panel supported by the CPT Advisory Committee is responsible for maintaining CPT®. Advisory Committee membership is limited to those national medical societies seated in the AMA House of Delegates.

Katharine Krol, MD currently serves on the CPT Advisory Committee as SIR’s CPT Advisor, overseeing CPT activities for SIR; supported by members of the SIR Economics Committee. SIR was instrumental in sponsoring and/or supporting CPT code applications resulting in the creation of, and revision to, codes for the following services:

There may be additional new and revised codes in CPT 2006 pertaining to interventional radiology services; the discussion of the codes presented is not comprehensive, and does not replace CPT, copies of which can be purchased via the AMA.

2006 MEDICARE PHYSICIAN FEE SCHEDULE DATA

FOR NEW INTERVENTIONAL RADIOLOGY CODES

CMS has released the 2006 Medicare Physician Fee Schedule detailing the RVU amounts and global periods established for these new codes.