Medicare Compliance & Reimbursement

Start identifying asymptomatic patients with advanced stenosis.

Cardiologists could soon be providing carotid artery stenting to a larger group of patients than before.

The Centers for Medicare & Medicaid Services (CMS) proposed to expand coverage for carotid artery stenting (CAS), to include patients who are asymptomatic. Currently, Medicare covers CAS only in patients who have symptoms of carotid artery stenosis (hardening of the arteries), or who are in a clinical trial.

But if the proposed coverage determination goes through, Medicare could cover CAS in patients with greater than 80 percent carotid artery stenosis ...quot; even if they have no symptoms. Or, if patients have symptoms and greater than 70 percent stenosis, CMS will also cover CAS. In either case, patients should be at high risk of carotid endarectomy (CEA).

The surgeon performing the surgical consultation that determines the patient is at high risk for CEA must "be properly credentialed to perform CEA as determined by the facility," CMS adds. Also, Medicare won't pay for carotid artery stenting if the physician is unable to use a distal embolic protection device.

CMS also takes away: But CMS also proposes to tighten its criteria for patients aged 80 or older. Medicare would stop covering CAS for these older patients due to safety concerns, unless they were enrolled in a Category B Investigational Device Exemption (IDE) trial.

Stenting can reduce the risk of stroke in the Medicare population, and approximately 70 percent of strokes happen in people aged 65 and older, CMS says.

Medicare appears to have recognized that CAS is a "less invasive treatment that is successful," says Laura Siniscalchi, a consultant with Deloitte & Touche in Boston.

Different population: Asymptomatic carotid artery stenosis patients are a different population than symptomatic ones, says one cardiology coder. Usually, with symptomatic patients, the physician must apply the stent within three hours of the symptoms appearing, or it won't be as effective. But with asymptomatic patients, you can identify candidates and plan ahead.

Resource: Read the proposed decision at www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=194.