Interventional Cardiology Gets New Codes, Lower Payments


Interventional cardiologists will be working with a number of new codes designed to better reflect the complexity of their patients and the intensive procedures they perform. But payments are still expected to decline in 2013.

The American Medical Association Current Procedural Terminology (CPT) Editorial Panel approved 13 new codes for reporting on percutaneous coronary interventions. The list includes several base codes for angioplasty, atherectomy, and stenting. In addition, the panel created add-on codes to be used by cardiologists when reporting on interventions conducted in additional branches of a major coronary artery.

The new code set also includes, for the first time, specific codes for the percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction (92941) and the percutaneous transluminal revascularization of chronic total occlusion (92943).

The changes represent a major paradigm shift in cardiac coding, according to Dr. Robert N. Piana, chair of the American College of Cardiology Coding Task Force.

Currently, if a physician performs a cardiac intervention in the main vessel plus one of the additional branches, it is coded with a single code. Under these new codes, cardiologists would use a base code to describe the procedure and an add-on code for each additional branch of a major coronary artery, according to Dr. Piana, director of the adult congenital interventional program at Vanderbilt Heart and Vascular Institute in Nashville, Tenn.

"We felt that this approach paralleled the methodology recently approved for lower extremity revascularization coding," he said, noting that the changes are geared to better reflect the work that cardiologists perform and to support appropriate valuation and reimbursement for more complex, intense, and time consuming procedures.

But it’s unclear if physicians will get a chance to use these new codes. In the 2013 Medicare Physician Fee Schedule final rule issued on Nov. 1, Medicare officials indicated that the agency would not pay physicians for the add-on codes.

In the rule, Medicare officials wrote that they rejected the add-on codes because of the potential that this type of coding system could provide an incentive for physicians to increase the placement of stents unnecessarily.

Officials at the American College of Cardiology and the Society for Cardiovascular Angiography and Interventions (SCAI) are reviewing the Medicare fee schedule rule and developing recommendations on whether physicians should report the add-on CPT codes even if they won’t be paid by Medicare.

Financial Implications

The decision by officials at the Centers for Medicare and Medicaid Services is a blow to the new coding paradigm, but its financial impact on physicians may be somewhat mitigated because Medicare increased payments for the base codes when it decided not to pay for the add-on codes.

The bottom line is that under either of the coding methodologies, physicians would see a cut in payments for interventional cardiology services, Dr. Piana said.

"I don’t think that there’s any question that there will be some reduction in reimbursement for physicians," he said.

Here are some examples of how payments are falling in interventional cardiology.

• Stenting: Under the current system, percutaneous transcatheter placement of an intracoronary stent with coronary angioplasty was valued at 14.82 RVUs (relative value units). In 2013, the CMS has assigned 11.21 RVUs for the stenting with angioplasty code (92928).

• Atherectomy: This year, percutaneous transluminal coronary atherectomy with coronary angioplasty is valued at 12.07 RVUs. In 2013, the value for atherectomy with angioplasty (92924) will drop to 11.99 RVUs.

• Angioplasty: Currently, percutaneous transluminal coronary angioplasty conducted alone is allotted 10.96 RVUs. Next year, the new angioplasty code (92920) will be valued at 10.10 RVUs.

In a few cases, physicians have a chance to earn more money. For instance, the CMS approved the creation of new codes for percutaneous transluminal revascularizations for inpatients with acute myocardial infarctions (92941) and chronic total occlusion (92943). The CMS valued both services at 12.56 RVUs.

While these two services represent only a small percentage of the total practice of an average interventional cardiologist, they are very intensive services, Dr. Piana said. "They will now be recognized in a way they were not before," he said.

The New Codes

92920: percutaneous transluminal coronary angioplasty; single major coronary artery or branch.

92921: each additional branch of a major coronary artery (the CMS will not pay for this code).

92924: percutaneous transluminal coronary atherectomy, with coronary angioplasty.

92925: each additional branch of a major coronary artery (the CMS will not pay for this code).

92928: percutaneous transcatheter placement of intracoronary stent, with coronary angioplasty.

92929: each additional branch of a major coronary artery (the CMS will not pay for this code).


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