Here's what the agency says about medically unlikely edits Keeping track of cardiology-related payer news and updates at this time of year is no easy feat. Here's a handy list to cure your information-overload blues. 1. Check Out Imaging Payment Reductions First, here's a bit of good news. Although CMS was supposed to increase the reduction in the technical component (TC) payment for additional cardiac imaging procedures (furnished on contiguous body parts during the same session), it chose to freeze last year's reduction amount. In other words, when you report two cardiac imaging procedures, you can expect full payment on the first procedure but a 25 percent reduction on the second, instead of the proposed 50 percent reduction in 2007.
But CMS now limits TC payment for most imaging procedures to the amount paid under the OPPS.
When your service is subject to both the multiple imaging reduction policy and the outpatient hospital cap, CMS first applies the multiple imaging adjustment and then the outpatient cap.
Resource: MLN Matters offers details on the new provisions with SE0665, "Multiple Procedure Reduction on the Technical Component (TC) of Certain Diagnostic Imaging Procedures and Cap on the TC of Imaging Procedures" at
www.cms.hhs.gov/MLNMattersArticles/downloads/SE0665.pdf.
Example: If your cardiologist performs the technical component of 71275 (Computed tomographic angiography, chest, without contrast material[s], followed by contrast material[s] and further sections, including image postprocessing) as well as the technical component of 74175 (Computed tomographic angiography, abdomen, without contrast material[s], followed by contrast material[s] and further sections, including image post-processing), these two codes are in the same family. In this case, CMS will pay the TC payment for the first procedure (71275) but a 25 percent reduction for the second (74175).
2. Seek Out Rules on AAA US Screening For dates of service Jan. 1 and later, Medicare will cover a one-time abdominal aortic aneurysm (AAA) ultrasound screening for patients who receive a referral due to an initial preventive physical exam, receive the ultrasound (US) from an authorized provider, haven't had a previous AAA US screening under Medicare, and either:
• has a family history of AAA or
• is a man 65 to 75 years of age who has smoked at least 100 cigarettes in his lifetime or
• is a beneficiary who manifests other risk factors specified by the secretary of health and human services through the national coverage determination process. You should report the ultrasound exam with G0389 (Ultrasound, B-scan and/or real time with image documentation; for abdominal aortic aneurysm [AAA] screening).
Resource: MLN Matters covers the basics in MM5235, "Implementation of an Ultrasound Screening for Abdominal Aortic Aneurysms (AAA)" at
www.cms.hhs.gov/MLNMattersArticles/downloads/MM5235.pdf. 3. Contend With Unlikely Edits Beginning January 2007, you'll have to contend with a new set of [...]
