Nuevos algoritmos diagnósticos de la enfermedad arterial periférica

Transcription

1 Nuevos algoritmos diagnósticos de la enfermedad arterial periférica! NCVH America Latina - Ventana a las Américas Marzo 25 al 28 de 2014 Salvatore J. Tirrito M.D., F.A.C.C. Pima Heart Associates Tucson, Arizona

2 Flochec How to increase your daily practice revenue! How to save legs

3 Flochec How to increase your daily practice revenue (Why is this important?)

4 Pima Heart Associates 25 Cardiologists 3 EPs 3 CTS 3 Vascular surgeons 3 PCPs 1 Endocrinologist

5 Pima Heart Associates 160 full time employees (with families that depend on them) Hundreds of other business we deal with everyday that rely on us and are able to stay in business due to businesses like us

6 Medical Economics 101 Medicine is the only business I know of that essentially operates in a completely backwards fashion compared to the rest of the world The costs of consumables (i.e. EKG electrodes, coffee cups, exam room paper etc..) continues to rise, and inflation demands that our employees (nurses, receptionists, billers, coders, IT folks etc..) get paid more and more Yet reimbursement for the physician continues to go down.

7 Medical Economics 101 So How Do We Make Ends Meet? See more patients (which obviously is time limited) Or get more value (physician value) out of the physician-patient interaction (billing appropriately) Findings ways to do things more cost effectively

8 FloChec System Pulse- Ox style clip measures microvascular perfusion at the level of the finger and toe Portable netbook- based applica<on presents results real- <me Provides hard- copy report with pulse volume recordings & bilateral flow index

9 CPT/HCPCS Codes! LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOWER EXTREMITY: ANKLE/ BRACHIAL INDICES AT DISTAL POSTERIOR TIBIAL AND ANTERIOR TIBIAL/ DORSALIS PEDIS ARTERIES PLUS BIDIRECTIONAL, DOPPLER WAVEFORM RECORDING AND ANALYSIS AT 1-2 LEVELS, OR ANKLE/ BRACHIAL INDICES AT DISTAL POSTERIOR TIBIAL AND ANTERIOR TIBIAL/DORSALIS PEDIS ARTERIES PLUS VOLUME PLETHYSMOGRAPHY AT 1-2 LEVELS, OR ANKLE/ BRACHIAL INDICES AT DISTAL POSTERIOR TIBIAL AND ANTERIOR TIBIAL/ DORSALIS PEDIS ARTERIES WITH TRANSCUTANEOUS OXYGEN TENSION MEASUREMENTS AT 1-2 LEVELS) What most vascular labs are billing for a traditional rest ABI study

10 93923 COMPLETE BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, 3 OR MORE LEVELS (EG, FOR LOWER EXTREMITY: ANKLE/BRACHIAL INDICES AT DISTAL POSTERIOR TIBIAL AND ANTERIOR TIBIAL/DORSALIS PEDIS ARTERIES PLUS SEGMENTAL BLOOD PRESSURE MEASUREMENTS WITH BIDIRECTIONAL DOPPLER WAVEFORM RECORDING AND ANALYSIS, AT 3 OR MORE LEVELS, OR ANKLE/BRACHIAL INDICES AT DISTAL POSTERIOR TIBIAL AND ANTERIOR TIBIAL/DORSALIS PEDIS ARTERIES PLUS SEGMENTAL VOLUME PLETHYSMOGRAPHY AT 3 OR MORE LEVELS, OR ANKLE/ BRACHIAL INDICES AT DISTAL POSTERIOR TIBIAL AND ANTERIOR TIBIAL/DORSALIS PEDIS ARTERIES PLUS SEGMENTAL TRANSCUTANEOUS OXYGEN TENSION MEASUREMENTS AT 3 OR MORE LEVEL(S), OR SINGLE LEVEL STUDY WITH PROVOCATIVE FUNCTIONAL MANEUVERS (EG, MEASUREMENTS WITH POSTURAL PROVOCATIVE TESTS, OR MEASUREMENTS WITH REACTIVE HYPEREMIA). What you should be billing for a rest ABI (with 3 or more levels) or exercise ABI with Heel lifts

11 93924 NONINVASIVE PHYSIOLOGIC STUDIES OF LOWER EXTREMITY ARTERIES, AT REST AND FOLLOWING TREADMILL STRESS TESTING, (IE, BIDIRECTIONAL DOPPLER WAVEFORM OR VOLUME PLETHYSMOGRAPHY RECORDING AND ANALYSIS AT REST WITH ANKLE/BRACHIAL INDICES IMMEDIATELY AFTER AND AT TIMED INTERVALS FOLLOWING PERFORMANCE OF A STANDARDIZED PROTOCOL ON A MOTORIZED TREADMILL PLUS RECORDING OF TIME OF ONSET OF CLAUDICATION OR OTHER SYMPTOMS, MAXIMAL WALKING TIME, AND TIME TO RECOVERY) COMPLETE BILATERAL STUDY Exercise ABI- Treadmill Only

12 The AMA's CPT panel recently confirmed you may not report code for your ankle/brachial index tests if a treadmill is not used for the exercise portion. Any other type of exercise done is not considered exercise for the billing of this code (Heel Lifts is not considered exercise).

13 These are the CPT codes/reimbursement and descriptions, these are to be billed when a treadmill is not done Noninvasive Limited bilateral upper or lower ext art w/ Doppler waveform recording and analysis at 1-2 levels Noninvasive Complete bilateral upper or lower ext art w/doppler waveform recording and analysis at 3 or more levels or single level with provocative measures- use this code for heel lifts

14 Reimbursement (West Coast) $92.38 Noninvasive Limited bilateral upper or lower ext art w/ Doppler waveform recording and analysis at 1-2 levels $ Noninvasive Complete bilateral upper or lower ext art w/ Doppler waveform recording and analysis at 3 or more levels $ ABI with exercise (Treadmill only) $ Lower Extremity Arterial Doppler without ABI Lower Extremity Arterial Doppler with ABI (assuming a 93922, 23, or 24 has not been done in the last 30 days)

15 Flochec Rest ABI Exercise ABI LEAD $ $92.38 $ $ $ < 5 min 30 min 1 hr 1.5 hr Trained Personnel Vascular Tech or special trained MA, nurse etc.. Vascular Tech or special trained MA, nurse etc.. Vascular Tech Patient limited 16 day 8 day 6 day

16 PAD Screening Algorithm (Using FloChec ) 187 patients (all comers) underwent a FloChec (Same Day) One month (Billed $52,234, 93923) (Received $24,611, $131/study) Cost approx $400/ month for Flochec machine lease 70.3 years Revenue Average Age Generating 414.1, Approach 272.4/427.31

17 PAD Screening Algorithm (Using FloChec ) Data 187 Flochecs 23 Positive (12.3%) LEAD 23x $190 = $4, normal studies (Non-obstructive disease) FP rate is 9.1% 6 abnormal studies (all with flow limiting disease) 9.1% FP Rate!!!

18 6 abnormal studies (all with flow limiting disease) All 6 were successfully revascularized 3/6 had no symptoms

19 Conclusions Flochec has a FP rate that is at least equal if not better than traditional exercise and rest ABI Flochec does not tie up expensive vascular technologists and take up lab time that could be utilized for other studies Flochec is same day revenue and does not have to inconvenience the patient by having them come back at another time for a test Flochec is easy to use, low cost to operate with a pretty solid reimbursement Flochec finds asymptomatic patients with real intervenerble disease before they lose a leg

20 Nuevos algoritmos diagnósticos de la enfermedad arterial periférica! NCVH America Latina - Ventana a las Gracias Américas Marzo 25 al 28 de 2014 Salvatore J. Tirrito M.D., F.A.C.C. Pima Heart Associates Tucson, Arizona