Cardiovascular specialists will find little joy in final regulations released by the Centers for Medicare & Medicaid Services (CMS). Changes for 2015 leave payments generally flat—at least until April 1, when the Sustainable Growth Rate (SGR) formula patch is scheduled to expire.
“[W]hile cardiologists will see modest payment increases for selected services, the annual threat of significant reductions in reimbursement due to the SGR formula creates an unsustainable path for physicians to provide quality care to patients and accentuates the need for a definitive solution,” said Patrick O’Gara, MD, president of the American College of Cardiology (ACC), in a statement.
The Society for Cardiovascular Angiography and Interventions stated that—putting the SGR threat aside—it found “no net change in payments” as of Jan. 1, 2015. The society noted one victory in the classification of cardiac catheterization and angioplasty services as surgical procedures to reflect the appropriate level of risk factors.
“We agree that the MP [malpractice] risk associated with the cardiac catheterization and angioplasty services mentioned by the commenters are more akin to surgical procedures than most non-surgical services,” CMS wrote. “Therefore, we will add cardiac catheterization and angioplasty services as described by HCPCS codes 92961, 92986, 92987, 92990, 92997 and 92998 to the list of services outside of the surgical HCPCS code range to be considered surgery for purposes of assigning service level MP risk factors.”
The ACC highlighted changes in coding for transesophageal echocardiography (TEE) guidance during structural heart interventions. Changes allow physicians to use the CPT code 93355. The college added that all TEE codes were reviewed and are scheduled for “modest increases in physician work on an interim-final basis.”
ACC added that CMS did not finalize a proposal to review of high expenditure codes such as SPECT-MPI, transthoracic echocardiography, stress echo and some device programming but that it acknowledged that a screen to spot misvalued codes would be useful.
The ACC also evaluated the Hospital Outpatient Perspective Payment System for cardiology-related changes. It noted that 25 proposed comprehensive Ambulatory Payment Classifications (APCs) were finalized for 2015, including APCs for automatic implantable cardiac defibrillator, pacemaker and related device procedures; electrophysiology procedures; and endovascular procedures. These will be considered primary services, which will affect how payment is reported.
CMS estimates that if the SGR is allowed to take effect on April 1, physicians will experience a 13.7 percent reduction in physician fees. That is about 10 percentage points less than had been projected earlier.