Cardiology Coding Alert

CMS has posted one proposed rule (fee schedule) sure to make you tighten your belt and another (MRI coverage) that offers a ray of hope. Add to that the final ICD-9 2010 rule, and you've got plenty to keep track of. Here's a crash course on these recent releases.

1. Could the '3 R' Requirement Be History?

For 2010, CMS plans to end payment for consult codes, according to the proposed Medicare Physician Fee Schedule, printed in the July 13 Federal Register (http://edocket.access.gpo.gov/2009/E9-15835.htm).

Less hassle, less cash? Instead of reporting consult codes, you'd report new or established patient office visit or hospital care (E/M) codes for these services, and CMS would increase payments for the existing E/M codes.

To determine the impact of this change, you'd have to compare the reimbursement from the new fee schedule office visit fees vs. the current office consult fees, as well as the new hospital visit E/M charges vs. the current hospital consult fees, says Quinten A. Buechner, MS, MDiv, CPC, ACS-FP/GI/PEDS, PCS, CCP, CMSCS, president of ProActive Consultants in Cumberland, Wis. Using this year's figures, you'd lose between $16 to $45 for office consults that would now be coded as new patient visits, and you'd lose $30 to $100 for established office consults coded as E/Ms, Buechner says. A rough calculation shows that planned additional E/M payments may not cover the loss of consult money.

More hits to the wallet: CMS is projecting a record 21.5 percent rate cut (proposed conversion factor is $28.3208), and the proposed rule (Table 39) indicates that cardiologists can expect practice expense and malpractice changes to drop cardiology reimbursement 11 percent.

Table 40 reveals deeper cuts for several services: 32 percent for 93510 (Left heart catheterization ...), and 38 percent each for 93000 (Electrocardiogram ...) and 93015 (Cardiovascular stress test ...), for example.

That means coding these services correctly the first time is more important than ever to your practice's financial health.

Cardiology Coding Alert, Vol. 12, No. 8, covered the proposed ICD-9 code changes for 2010. Now the final list is out. Be sure you catch one of the revisions that didn't make it into the proposed rule:

• 2009: 453.2 -- Other venous embolism and thrombosis; of vena cava

• 2010: 453.2 -- Other venous embolism and thrombosis; of inferior vena cava.

This change clarifies that 453.2 is not appropriate for the superior vena cava, the large vein which returns blood to the heart from the head, neck, and both upper limbs.

The inferior vena cava instead returns blood to the heart from the lower body.

Resources: You can find the final list of codes at www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/07_summarytables.asp. And the addendum is available online at www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm.

By September's end, CMS should declare whether CMS will allow coverage of your MRI for blood flow claims. Currently, Section 220.2 of the National Coverage Determination (NCD) manual lists blood flow measurement in the nationally non-covered indications. As a result, Medicare hasn't covered the following codes:

• 75558 -- Cardiac magnetic resonance imaging for morphology and function without contrast material; with flow/velocity quantification

• 75560 -- ... with flow/velocity quantification and stress

• 75562 -Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with flow/velocity quantification

• 75564 -... with flow/velocity quantification and stress.

Many of the public comments aimed at the coverage analysis echoed those of Erik Schelbert, MD, cardiovascular magnetic resonance director for the University of Pittsburgh: "As the Letter from the various Colleges and Societies clearly attests, CMR measurements of flow are absolutely necessary for assessment of patients with valvular heart disease and congenital heart disease."

Watch your contractor's policy: The proposed decision memo acknowledges that evidence doesn't support blanket noncoverage. If CMS removes "blood flow measurement" from the nationally noncovered list, individual contractors would be responsible for deciding coverage.

MRI coverage for patients with pacemakers isn't looking as good, though. In the same proposed decision memo, CMS states that after considering a request from Medtronic for a change, CMS plans to maintain its policy that MRI "is not covered for patients with cardiac pacemakers or with metallic clips on vascular aneurysms."

Resource: Links to open coverage analyses are available here: www.cms.hhs.gov/mcd/index_list.asp.