Interventional cardiologists can toast some coding changes when they ring in the New Year, including a new specialty designation that more accurately portrays performance.
The Society for Cardiovascular Angiography and Interventions (SCAI) presented an update Dec. 15 on coding and payment to prepare members for changes scheduled to go into effect, some as early as Jan. 1, 2015. The update addressed CPT codes and modifiers, claims issues and other topics.
Starting in 2015, interventional cardiologists can elect to be identified under the C3 designation, a specialty code that will allow for an apples-to-apples comparison of performance scores that get linked to physician profiles. “Right now we are being compared to physicians who do not do the same type of work we do and that has been to our detriment,” said Peter Duffy, MD, chair of SCAI’s advocacy and government relations committee and director of quality for the cardiovascular service line at FirstHealth of the Carolinas Reid Heart Institute at Moore Regional Hospital in Pinehurst, N.C. “That goes across the board to not only payers and government but also to patients and public perceptions.”
For instance, grouping general cardiologists with interventional cardiologists might produce results that erroneously suggest overutilization among interventionalists. Being able to compare interventional cardiologists with their peers will eliminate the distortion, help identify outliers and improve performance, he said.
He predicted that the change also will reduce the number of denied claims because it can be show that services are not duplicative.
Duffy added that C3 is a self-designation. He recommended interventional cardiologists contact their local carrier if they want their designation changed, a process that will then update their profiles.
Cliff Kavinsky, MD, PhD, chair of the structural heart disease committee and a cardiologist at Rush University Medical Center in Chicago, outlined transcatheter mitral valve repair (TMVR) updates. Now physicians use TMVR Category III (emerging technology) codes, which will change on Jan. 1 to Category I (established technology).
He warned that a correction for codes involving TMVR co-surgeons is in the works, and the rules for modifier options for co-surgeons and assistant-at-surgery are complicated. The SCAI committee recommends that physicians hold all co-surgeon claims until the correction is made but that assistant-at-surgery claims can be submitted with prepayment documentation in support their medical necessity.
“We are very optimistic that we will obtain approval from CMS (Centers for Medicare & Medicaid Services) to fix this problems so that it comes more in line with the national coverage determination,” Kavinsky said.
In addition, modifier 59 will be phased out and the more specific modifiers XE, XS, XP and XU will kick in on Jan. 1 for ad hoc PCIs. CMS will accept either 59 or its replacements. Kavinsky emphasized the need to be clear and comprehensive in documentation. “It is our recommendation that you may as well get comfortable with these new modifiers,” he said.