Q&A | Breaking the Code for Vascular Surgery Reimbursement

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 - Teri Romano, RN
Teri Romano, RN

Several vascular surgery codes have undergone changes and more coding modifications will occur this year. With the Centers for Medicare & Medicaid Services (CMS) moving toward bundled payments, vascular surgeons are facing dwindling reimbursement. How can they ensure adequate payments? Teri Romano, RN, MBA, a consultant at Karen Zupko & Associates in Chicago, provides tips.  

Q. What are the challenges in coding and reimbursement for vascular surgeons?

Romano: Moving toward bundled codes and payments has been, and will continue to be, the greatest hurdle for vascular surgeons. Procedures previously reported and billed as individual procedures are now bundled into a single code.  

Last year, we saw the complete bundling of the most common procedure vascular surgeons perform—lower extremity revascularization, which includes PCI and atherectomy of the lower extremities. Previously, the surgeon would use component coding for these procedures; now catheterization, radiological supervision, interpretation and other interventions performed during procedures are bundled into a single code. Sixteen codes were introduced as an attempt to make procedures more uniform. Atherectomy procedures were downgraded from Category I to Category III codes, making it even more difficult to get paid.  

Q. What changes have occurred in 2012?

Romano: Vascular surgeons have seen the bundling of renal angiography payments. Previously, the surgeon could bill for two codes—catheterization of the renal artery and angiography. On Jan. 1, these two procedures were bundled into a single code.

Inferior vena cava (IVC) filter codes also have been bundled. Previously, when a surgeon placed an IVC filter, he or she could bill under component coding rules for catheterization, imaging and placement of the IVC catheter.

Q. What impact will these changes have on reimbursement?

Romano: The more we bundle codes, the more it cuts into reimbursement. In vascular surgery, the concept of component coding allows each activity in a procedure to be billed separately. There are a significant number endovascular procedures that are billed together more than 75 percent of the time, which is what Medicare examines with the intention of bundling. There is a threat here, particularly to vascular surgeons. The test will be maintaining reimbursement as Medicare continues to find codes that are routinely billed together and bundles them to reduce reimbursement to providers.  

Bundled payments are significantly torturous for vascular surgery because the specialty is so Medicare-patient heavy. Nearly 70 to 80 percent of patients who undergo vascular surgery are Medicare recipients, compared with the 15 to 20 percent of patients who undergo neurosurgery who are Medicare recipients.

Q. How will the Global Surgical Package impact billing and reimbursement?

Romano: Surgeons get paid a flat fee for their procedures. For this flat fee, the surgeon performs the pre-operative, operative and post-operative care, including the 90-day global period. If the patient is readmitted or has a follow-up visit, this is included in the flat fee. In contrast, open endovascular procedures have a zero-day global period covering only the operative session.  

Q. How should vascular surgeons gear up for the ICD-10 transition?

Romano: ICD-10 has many more codes and more specific documentation, so it may require doctors to provide greater detail in their evaluation, management and operative documentation. Vascular surgeons should perform a gap analysis comparing the current codes and ICD-10 codes to identify gaps in documentation. This will be a big change if the Oct 1, 2013 deadline sticks.