Question:
I've heard that payment for ECP is decreasing in 2010. Where can I find more information on G0166? California Subscriber
Answer:
Check out the
Medicare Claims Processing Manual, Chapter 32, Section 130, and the
Medicare National Coverage Determinations Manual, Chapter 1, Section 20.20, for more information on G0166 (
External counterpulsation, per treatment session).
RVUs:
The drop in relative value units (RVUs) isn't too substantial, changing from 4.16 in 2009 to 4.03 in 2010.
ECP:
The manuals explain that ECP is a non-invasive treatment for coronary artery disease. Medicare covers the service for patients with stable angina if the cardiologist decides they aren't good surgery candidates. CMS has a specific list of reasons patients aren't amenable to surgery, such as having an inoperable condition or risk-creating comorbidities.
You'll find a long list of codes you shouldn't report alongside G0166 unless you can prove they were separate and distinct. These include (among others):
• 92971 (Cardioassist-method of circulatory assist;external)
• monitoring tests such as 93040-93041 (Rhythm ECG, 1-3 leads ...)
• E/M codes such as 99201-99215 (Office or other outpatient visit ...)
"A full course of therapy usually consists of 35 one-hour treatments which may be offered once or twice daily,usually 5 days per week," the NCD manual states.