American Society of Echocardiography 2014 Coding and Reimbursement Newsletter

Transcription

1 May American Society of Echocardiography Coding and Reimbursement Newsletter The ASE Coding and Reimbursement Newsletter is a resource for cardiovascular ultrasound procedures provided in the facility and office settings. These newsletters, and the opportunity to submit questions to our coding consultant, are provided exclusively to members of ASE. Judy Rosenbloom, President of JR Associates, provides these services. For questions or comments, write to reimbursement@asecho.org. Physician Fee Schedule (PFS) s Medicare payments for physicians services (including payment for the interpretation of echocardiograms (professional component or PC )) and payment for physicians office overhead, clinical staff equipment and supplies (technical component or )) are influenced by the Sustainable Growth rate (SGR), relative value units (s) and various billing and payment policies. Medicare physician payment rates are set with a formula based on economic growth known as the "sustainable growth rate" (SGR). Because spending on physician services has outpaced growth, the formula has called for cuts in reimbursement each year over the past decade. A 24 reduction in reimbursement was designated for. As in previous years, to avert the cut, Congress passed a temporary solution: The Protecting Access to Medicare Act of was signed into law on April 1,. The bill prevents a 24 cut in reimbursement for physicians treating Medicare patients on April 1, and replaces it with a 0.5 update (through December 31, ) and a 0 update from January 1 until April 1, The National Average Medicare fee schedule amounts are the product of three factors: s x Conversion Factor (CF) = National Average (See Table 1 list) Relative Value Units (): For each procedure/service represented by a code, three components are assigned; to account for the relative resource costs used to provide a service/ procedure. o o o Physician work: reflects relative levels of physician time/ intensity associated with furnishing a service Practice expense (): reflects practice costs (e.g., office space, supplies and equipment, and staff) Malpractice expense (): represents payment for the professional liability expenses Geographic Practice Cost Indices (GPCI) account for the geographic differences in the cost of practice across the country. CMS calculates an individual GPCI for each of the components. Conversion Factor (CF) is a dollar amount used to convert s into a payment amount adjusted for budget neutrality (which accounts for meeting the target SGR). The CF is updated annually and is $ for. : (See Table 2) Echocardiography: Medicare payment for the equipment, supplies, non-physician personnel and overhead involved in the provision of echocardiography services ( Technical Component or ) in non-hospital settings increased substantially in, with s increasing by 23 for the of the most commonly performed echo services ( TTE with spectral and color Doppler) and an approximate 15 increase in Medicare payment for the global service (PC and combined).. The Medicare payment increase for stress echo ( 93351) is in the same range (23 increase for the and 14 increase for the global service). The increased payment for echo services resulted primarily from the inclusion of an ultrasound room in the echo allowances, similar to the ultrasound room used to compute payment for other ultrasound services. This change was made in large part in response to comments made by ASE over a period of years; however CMS is continuing to examine the issue and ASE is working with ACC to ensure that the increased rates are maintained. Vascular: Various technical adjustments have been made to the s, resulting in payment decreases for some vascular procedures. {D DOCX / 1 }" copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association."

2 Table 1 Comparison of Relative Value Units from to HCPCS/ ECHOCARDIOGRAPHY TTE Change - TTE congenital complete TTE congenital complete TTE congenital complete TTE congenital fwup or lmtd TTE congenital fwup or lmtd TTE congenital fwup or lmtd TTE w/ Doppler complete TTE w/ Doppler complete TTE w/ Doppler complete TTE w/o Doppler complete TTE w/o Doppler complete TTE w/o Doppler complete TTE fw-up or lmtd TTE fw-up or lmtd TTE fw-up or lmtd TEE TEE TEE TEE TEE TEE {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 2

3 HCPCS/ Change - TEE TEE TEE TEE TEE TEE TEE TEE TEE intraop TEE intraop TEE intraop Doppler Doppler echo exam Doppler echo exam Doppler echo exam Doppler echo exam Doppler echo exam Doppler echo exam Doppler color flow add-on Doppler color flow add-on Doppler color flow add-on Stress Echo Stress TTE only Stress TTE only Stress TTE only Stress TTE complete Stress TTE complete {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 3

4 HCPCS/ Change - Stress TTE complete Admin ECG contrast agent Fetal Echo D 3D render w/o post process D render w/o post process D render w/o post process {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 4

5 HCPCS/ Change - 3D rendering w/ post process D rendering w/ post process D rendering w/ post process VASCULAR AAA Screening Ultrasound exam AAA screen G0389 Ultrasound exam AAA screen Ultrasound exam AAA screen Carotid Duplex Extracranial Extracranial Extracranial Extracranial Extracranial Extracranial D Intracranial Intracranial Intracranial Intracranial Intracranial Intracranial Tcd vasoreactivity {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 5

6 HCPCS/ Change - Tcd vasoreactivity Tcd vasoreactivity Tcd emboli detect w/o inj Tcd emboli detect w/o inj Tcd emboli detect w/o inj Tcd emboli detect w/inj Tcd emboli detect w/inj Tcd emboli detect w/inj Peripheral Arterial Upr/l xtremity art 2 levels Upr/l xtremity art 2 levels Upr/l xtremity art 2 levels Upr/lxtr art stdy 3+ lvls Upr/lxtr art stdy 3+ lvls Upr/lxtr art stdy 3+ lvls Lwr xtr vasc stdy bilat Lwr xtr vasc stdy bilat Lwr xtr vasc stdy bilat Lower extremity Lower extremity {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 6

7 HCPCS/ Change - Lower extremity Lower extremity Lower extremity Lower extremity Upper extremity Upper extremity Upper extremity Upper extremity Upper extremity Upper extremity Venous Extremity Extremity Extremity Extremity Extremity Extremity Extremity Extremity Extremity Extremity Abdominal Duplex Vascular Vascular {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 7

8 HCPCS/ Change - Vascular Vascular Vascular Vascular Vascular Vascular Vascular Vascular Vascular Vascular Hemodialysis Duplex Doppler flow testing Doppler flow testing Doppler flow testing {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 8

9 Table 2 National Average Medicare PFS s: Echocardiography and Vascular Ultrasound HCPCS/ $ Change - Change - ECHOCARDIOGRAPHY TTE $198 $239 $42 21 Transthoracic echocardiography for congenital cardiac anomalies; complete $135 $175 $39 29 $62 $64 $2 4 $131 $159 $27 21 Transthoracic echocardiography for congenital cardiac anomalies;follow-up or limited $95 $121 $ 27 $36 $37 $1 3 Echocardiography, transthoracic, real-time with image $190 $229 $40 21 documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler $128 $165 $37 29 echocardiography, and with color flow Doppler echocardiography $62 $64 $ Echocardiography, transthoracic, real-time with image $114 $133 $18 16 documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler $70 $87 $17 24 echocardiography $44 $46 $2 4 Echocardiography, transthoracic, real-time with image $100 $124 $23 23 documentation (2D), includes M-mode recording, when performed, follow-up or limited $76 $98 $22 29 $25 $ $1 4 TEE Echocardiography, transesophageal, real time with image $306 $334 $28 9 documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, $204 $227 $24 12 interpretation and report $102 $106 $ Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); placement of transesophageal probe only $41 $43 $ * * Echocardiography, transesophageal, real time with image $285 $309 $24 8 documentation (2D) (with or without M-mode recording); $227 $249 $22 10 image acquisition, interpretation and report only $59 $61 $2 3 Transesophageal echocardiography for congenital $0 $0 $0 $0 cardiac anomalies; including probe placement, image acquisition, interpretation and report $0 $0 $0 $0 $136 $140 $5 3 Transesophageal Echocardiography (TEE) for congenital cardiac anomalies; placement of transesophageal probe only $42 $43 $1 4 Transesophageal Echocardiography (TEE) for congenital $0 $0 $0 $0 cardiac anomalies; image acquisition, interpretation and report only. $0 $0 $0 $0 $92 $95 $ * Echocardiography, transesophageal (tee) for monitoring purposes, including probe placement, real time 2- $0 $0 $0 $0 {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 9

10 HCPCS/ $ Change - Change - dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically $0 $0 $0 $0 changing) cardiac pumping function and to therapeutic measures on an immediate time basis $110 $114 $4 4 Doppler Doppler echocardiography, pulsed wave and/or $45 $55 $10 22 continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); $27 $36 $9 35 complete. $18 $19 $1 3 Doppler echocardiography, pulsed wave and/or $24 $31 $7 31 continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); followup or limited. $17 $24 $7 42 $7 $8 $0 5 Doppler echocardiography color flow velocity mapping $20 $ $6 30 (List separately in addition to codes for echocardiographic imaging) $16 $23 $6 38 $4 $4 $0-4 Stress Echo Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when $200 $242 $42 21 performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation $131 $170 $39 30 $70 $72 $3 4 Echocardiography, transthoracic, real-time with image $234 $282 $47 20 documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically $151 $195 $44 29 induced stress, with interpretation $83 $86 $ Use of echocardiographic contrast agent during stress echocardiography (List separately in addition to code for primary procedure) Stress Test Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report. Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report. Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress;interpretation and report only Fetal Echo $35 $34 -$1-3 $80 $76 -$4-5 $21 $22 $1 4 $44 $39 -$5-11 $14 $15 $ Echocardiography, fetal, cardiovascular system, real time $222 $277 $55 25 with image documentation (2D) with or without M-mode recording; complete $141 $193 $52 37 {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 10

11 HCPCS/ $ Change - Change - $81 $84 $ $134 $166 $32 24 Echocardiography, fetal, cardiovascular system, real time with image documentation (2D) with or without M-mode $93 $124 $31 33 recording; follow up or repeat $40 $42 $1 4 $61 $76 $16 Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete $33 $47 $15 45 $28 $29 $1 4 $45 $53 $8 19 Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat $18 $25 $7 42 $27 $28 $1 4 3-D D rendering with interpretation and reporting of $60 $29 -$31-52 computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring $51 $19 -$32-63 image post-processing on an independent workstation $10 $10 $1 5 3D rendering with interpretation and reporting of $83 $84 $2 2 computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; requiring $45 $44 -$1-1 image post-processing on an independent workstation $38 $40 $2 5 Contrast Agents Q9955 Perflexane Lipid microspheres, per ml Average Q9956 Octafluoropropane microspheres, per ml Average Q9957 Perflutren lipid microspheres, per ml Average VASCULAR G0389 AAA Screening Average Average Average Average Average Average Average Average Average Ultrasound B-scan and/or real time with image $111 $66 -$45-40 documentation; for abdominal aortic aneurysm (AAA) screening $83 $37 -$46-56 $28 $29 $1 5 Carotid $244 $192 -$52-21 Duplex scan of extracranial arteries; complete bilateral $215 $162 -$54-25 $29 $30 $2 5 $176 $124 -$52-29 Duplex scan of extracranial arteries; unilateral or limited $156 $104 -$53-34 $20 $21 $1 5 D $381 $361 -$ Transcranial Doppler of the intracranial arteries; complete $333 $312 -$21-6 $47 $49 $2 4 {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 11

12 HCPCS/ $ Change - Change $221 $211 -$10-4 Transcranial Doppler of the intracranial arteries; limited $190 $179 -$11-6 $31 $32 $1 3 $299 $291 -$8-3 Transcranial Doppler of the intracranial arteries; vasoreactivity $250 $240 -$10-4 $49 $52 $2 5 Transcranial Doppler of the intracranial arteries; $338 $339 $1 0 emboli detection without intravenous microbubble injection $281 $279 -$2-1 $57 $60 $ $361 $350 -$11-3 Transcranial doppler of the intracranial arteries; emboli detection with intravenous microbubble injection $303 $290 -$13-4 $58 $60 $2 4 Peripheral Arterial Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior $94 $89 -$5-5 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 $82 $77 -$5-6 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) $12 $12 $0 2 Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for $146 $140 -$6-4 lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with $125 $117 -$7-6 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 $22 $23 $1 4 transcutaneous oxygen tension measurements at 3 or more level(s), or single level with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia) 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 $183 $176 -$7-4 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 $159 $151 -$8-5 $24 $25 $1 4 $257 $248 -$ Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral $218 $207 -$11-5 $39 $40 $ $148 $142 -$5-4 Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited $123 $117 -$6-5 $25 $25 $1 4 {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 12

13 HCPCS/ $ Change - Change - $245 $231 -$14-6 Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral $223 $208 -$15-7 $22 $23 $1 4 $164 $158 -$6-4 Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited $149 $143 -$7-5 $15 $16 $1 5 Venous Extremity Noninvasive physiologic studies of extremity veins, $1 $122 -$4-3 complete bilateral (eg, doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography) $109 $104 -$5-5 $17 $18 $1 5 Duplex scan of extremity veins including responses to $194 $189 -$5-2 compression and other maneuvers; complete bilateral $159 $153 -$6-4 $34 $36 $1 4 Duplex scan of extremity veins including responses to $117 $115 -$2-2 compression and other maneuvers; unilateral or limited $95 $92 -$4-4 $22 $23 $1 5 Abdominal Duplex Duplex scan of arterial inflow and venous outflow of $369 $362 -$8-2 abdominal, pelvic, scrotal contents and/or retroperitoneal $282 $271 -$11-4 organs; complete $87 $91 $4 4 Duplex scan of arterial inflow and venous outflow of $214 $214 -$1 0 abdominal, pelvic, scrotal contents and/or retroperitoneal $156 $152 -$4-3 organs; limited $59 $62 $3 5 $237 $227 -$10-4 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete $205 $194 -$11-6 $32 $33 $1 3 $164 $157 -$7-4 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited $143 $135 -$8-5 $21 $22 $1 4 Hemodialysis Access Duplex $210 $196 -$ Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow) $198 $183 -$15-7 $12 $13 $1 5 * Modifier indicates the physician professional component (for billing purposes). Imaging procedures require reporting of this modifier when the physician s professional services are performed outside of the physician office setting (e.g., hospital). When the procedure is provided in the non-facility setting (i.e. physician office), the code is reported with no modifier appended (global billing: professional component [-] +technical component []). Certain procedures (e.g., stress tests, TEE probe insertion) are not designated with /PC modifiers. **DRA cap applies. Refer to OPPS for payment reference {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 13

14 Hospital Outpatient Procedure s Hospitals are reimbursed by Medicare for outpatient procedures and services under the Outpatient Prospective System (OPPS), which utilizes the Ambulatory Classification (APC) system. Services are reported with codes and/or HCPCS C-codes; each payable code is designated to an APC group. APC groups contain services that are clinically similar and generally require similar resources. Each APC is assigned a payment rate. When multiple codes are reported at the same encounter, the hospital may be paid for more than one APC. s to hospitals cover resources such as equipment, supplies, and staff. for the APC does not include physician reimbursement. Medicare payment to hospital outpatient departments for echo services under the APC system increased by 6-18 in, with increases for most hospital outpatient echo services in the 9 range. Medicare payment for contrast-enhanced procedures also increased (from 13-15), and Medicare payment for many vascular procedures increased substantially (in the range of 21-35). Table 3 - / Comparison: Echocardiography and Vascular Ultrasound Hospital Outpatient s HCPCS/ APC ECHOCARDIOGRAPHY APC TION TTE $ change change Transthoracic echocardiography for congenital cardiac anomalies; complete $559 $594 $36 6 Transthoracic echocardiography for congenital cardiac anomalies; f/u or limited $390 $427 $37 9 Echocardiography, transthoracic, real-time with image documentation (2D), includes M- mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography $390 $427 $ * Echocardiography, transthoracic, real-time with image documentation (2D), includes M- mode recording, when performed, complete, without spectral or color Doppler echocardiography Echocardiography, transthoracic, real-time with image documentation (2D), includes M- mode recording, when performed, follow-up or limited $390 $427 $37 9 $213 $251 $ ** TEE Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); placement of transesophageal probe only Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); image acquisition, interpretation and report only $559 $594 $36 6 $390 $427 $37 9 N/A N/A N/A N/A {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 14

15 HCPCS/ APC APC ** TION Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report Transesophageal Echocardiography (TEE) for congenital cardiac anomalies; placement of transesophageal probe only Transesophageal Echocardiography (TEE) for congenital cardiac anomalies; image acquisition, interpretation and report only. Echocardiography, transesophageal (tee) for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis $ change change $390 $427 $37 9 $559 $594 $36 6 N/A N/A N/A N/A $559 $594 $ ** ** ** Doppler Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete. Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); follow-up or limited. Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiographic imaging) Stress Echo Echocardiography, transthoracic, real-time with image documentation (2D), includes M- mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $390 $427 $ Echocardiography, transthoracic, real-time with image documentation (2D), includes M- mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation $559 $594 $ Use of echocardiographic contrast agent during stress echocardiography (List separately in addition to code for primary procedure) N/A N/A N/A N/A Stress Test {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 15

16 HCPCS/ APC APC TION Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report $ change change N/A N/A N/A N/A Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; physician supervision only, without interpretation and report. N/A N/A N/A N/A Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report. Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress;interpretation and report only $177 $244 $67 38 N/A N/A N/A N/A Fetal Echo Echocardiography, fetal, cardiovascular system, real time with image documentation (2D) with or without M-mode recording; complete Echocardiography, fetal, cardiovascular system, real time with image documentation (2D) with or without M-mode recording; follow up or repeat Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat 3-D 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; not requiring image post-processing on an independent workstation $213 $251 $38 18 $213 $251 $38 18 $65 $90 $25 39 $65 $90 $25 39 N/A N/A N/A N/A D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality; requiring image postprocessing on an independent workstation N/A N/A N/A N/A C Echocardiography With Contrast Transthoracic Echocardiogram with contrast for congenital cardiac anomalies; complete $578 $654 $76 13 {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 16

17 HCPCS/ APC APC C TION Transthoracic Echocardiogram with contrast for congenital cardiac anomalies; follow-up or ltd $ change change $434 $501 $67 15 C Transthoracic Echocardiogram with contrast, real-time with image documentation (2D) with or without M-Mode recording; complete $434 $501 $67 15 C Transthoracic Echocardiogram with contrast, real-time with image documentation (2D) with or without M-Mode recording; follow-up or limited $434 $501 $67 15 C C Transesophageal Echocardiogram (TEE) with contrast, real time with image documentation (2D) with or without M-Mode recording; including probe placement, image acquisition, interpretation and report Transesophageal Echocardiogram (TEE) with contrast for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report $578 $654 $76 13 $578 $654 $76 13 C Transesophageal Echocardiogram (TEE) with contrast for monitoring purposes; including probe placement, real time 2D image acquisition and interpretation leading to continuous assessment of cardiac pumping function and to therapeutic measure on an immediate time basis $434 $501 $67 15 C Transthoracic Echocardiogram (TTE) with contrast, real time image documentation (2D) with or without M-Mode recording; during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report $578 $654 $76 13 C Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes m-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography $578 $654 $76 13 C Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervision $578 $654 $76 13 Contrast Agents Q Perflexane Lipid microspheres, per ml N/A N/A N/A N/A Q Octafluoropropane microspheres, per ml N/A N/A N/A N/A {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 17

18 HCPCS/ APC APC TION $ change Q Perflutren lipid microspheres, per ml N/A N/A N/A N/A G VASCULAR AAA Screening Ultrasound B-scan and/or real time with image documentation; for abdominal aortic aneurysm (AAA) screening Carotid change $99 $90 -$9-9 Duplex scan of extracranial arteries; complete bilateral $155 $191 $ Duplex scan of extracranial arteries; unilateral or limited D Transcranial Doppler of the intracranial arteries; complete Transcranial Doppler of the intracranial arteries; limited Transcranial Doppler of the intracranial arteries; vasoreactivity Transcranial Doppler of the intracranial arteries; emboli detection without intravenous microbubble injection Transcranial doppler of the intracranial arteries; emboli detection with intravenous microbubble injection Peripheral Arterial $155 $191 $36 23 $155 $191 $36 23 $65 $135 $ $99 $135 $35 35 $99 $135 $35 35 $99 $135 $ 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) $67 $70 $4 6 {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 18

19 HCPCS/ APC APC TION $ change change 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 with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia) $109 $131 $ 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 $109 $131 $ Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited Venous Extremity Noninvasive physiologic studies of extremity veins, complete bilateral (eg, doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography) Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral $155 $191 $36 23 $99 $135 $35 35 $155 $191 $36 23 $99 $135 $35 35 $109 $131 $22 21 $155 $191 $36 23 {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 19

20 HCPCS/ APC APC TION Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited Abdominal Duplex Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete $ change change $99 $135 $35 35 $155 $191 $ Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited $155 $191 $ Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited Hemodialysis Duplex Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow) $155 $191 $36 23 $99 $135 $35 35 $99 $135 $35 35 ** 76376, 76377, 93314, 93317, 93320, 93321, 93325, Q9955, Q9956 and Q9957 have status code N - Packaged into an APC code. + Status code M - Items and Services Not Billable to the Fiscal Intermediary/MAC ++ Status code B - Codes Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 20

21 Multiple Procedure Reduction: Technical Component of Diagnostic Cardiovascular Procedures Physician/Office s Under the Medicare Physician Fee Schedule, the Multiple Procedure Reduction (PR) on diagnostic cardiovascular procedures applies when multiple services are furnished to the same patient on the same day. The PRs apply to technical component only () services, and to the of global services for those procedures assigned a status indicator of 6. Echocardiography and vascular ultrasound procedures are designated as status indicator 6 and are eligible for this discount. Full payment is made for the service with the highest payment under the Medicare Physician Fee Schedule. is made at 75 for subsequent services furnished by the same physician (or by multiple physicians in the same group practice) to the same patient on the same day. Example: (TTE) and (SCT) are Status Indicator 6 on the FS. Code Code payment Calculation PC $ 80 $ 64 $ 144 no reduction $ 407 $ 165 $ 531 $407 + (.75x$165) Global $ 486 $ 190 $ 674 $144 +$407+(.75x$165) The PRs do not apply to professional component (PC) services. This Medicare policy does not apply to hospital outpatient services. Note: some insurance companies may adopt or plan to adopt a similar type of policy for their non-medicare healthplans. In the May bulletin, UnitedHealthcare announced their intent to initiate a policy by Q3. Frequently Asked Coding Questions (FAQ) 1. Is there a limited TEE code? There is no "limited" code for TEE. The TEE codes were not established based on the distinction of complete or limited, and the Introductory language does not specify what is considered a complete or limited for these procedures. There is no guidance as to what anatomy is included in a TEE exam. 2. Does a bicuspid aortic valve finding on TTE qualify for congenital TTE? The manual is not specific, but the August Assistant does state: congenital disease, which includes defects such as atrial and ventricular septal defects, patent ductus arteriosis, Tetralogy of Fallot, transposition of the great arteries, single ventricle, and congenital defects of the cardiac valves. 3. What modifiers are applicable to echocardiography? Modifiers consist of two alphanumeric characters. Because modifiers may affect payment, they must be used correctly or claims may be denied and an audit may be initiated by a payer. Documentation in the medical record or interpretation report must support the use of a modifier. The AMA codebook defines modifier usage. In some cases, CMS and other payers may establish varying guidelines different from the AMA. A complete list of modifiers can be found on the inside cover page of the AMA codebook. Note, there are separate lists for hospital and physician approved modifiers. Modifiers to Report Technical and Professional Components: These modifiers are used with diagnostic testing codes, as they have two components: technical and professional. For payment purposes under the Medicare Part B Physician Fee Schedule (PFS), two modifiers ( and ) are used to describe the circumstances when diagnostic testing services are reported separately by the physician and the outpatient setting that is covered under the Medicare PFS (i.e. imaging center and office). The acquisition of the image is the technical component, and the professional component is the physician interpretation of the exam. - Technical component: The technical component provided in ambulatory settings such as doctors offices and IDTFs is reported by adding modifier to the code. The modifier is reported by the entity that only provides the technical service. Institutions such as hospitals do not append the modifier. The use of this modifier affects payment. {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 21

22 - Professional Component: The physician service only is reported separately by adding modifier - to the code. The use of this modifier affects payment. No modifier: When both components are furnished by one provider, Medicare makes a single global payment that is equal to the sum of the payment for the components. No modifier is necessary. Note that some codes such as stress test codes ( ) and stress echocardiography contrast administration (93352) are designated as global codes and are never reported with - or modifiers. The following codes may be reported with these modifiers: ,93315,93317,93318, 93320, 93321, 93325, 93350, Increased Procedural Services: This modifier is used to identify that the work required to provide a service is substantially greater than typically required. Modifier 22 is not a hospital approved modifier. The appropriate use of this modifier is subject to payer discretion and typically will trigger individual claim review. Specifically, CMS restricts the use of modifier -22 to only surgical procedures that have a global period of 0, 10, or 90 days. For Medicare claims, it would be inappropriate to append modifier -22 to cardiovascular ultrasound procedures. The following modifiers may be appropriate for all echocardiography codes, depending upon the circumstances: -51 Multiple Procedures: When multiple procedures, other than E/M services, Physical Medicine and Rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). Note: This modifier should not be appended to designated "add-on" codes. -52 Reduced Services This modifier is used to describe a service or procedure that is partially reduced or eliminated. It is approved for physician and hospital use. As an example, this modifier can be used to report an arterial extremity ( ) on a patient with an above the knee amputation, since the procedure was not performed in its entirety. -59 Distinct Procedural Service: This modifier is used to report procedures that are not normally reported together but are appropriate under the circumstances. Modifier59 is used to clearly designate non routine instances when distinct and separate multiple services are provided to a patient on a single date of service. It is approved for physician and hospital use. Modifier -59 should only be used if no other modifier more appropriately describes the relationships of the two or more procedure codes. As an example, if a transthoracic echo (93306) is done for a particular indication, and based on the result, a TEE is also performed; the 59 modifier would be appended to the TEE (93312). 77 Repeat Procedure by Another Physician: This modifier defines a repeat procedure by another physician during the same patient encounter. It is approved for physician and hospital use. As an example, when a TEE procedure is repeated by another physician, the second exam would require use of the 77 modifier and assumes that the second physician was aware this was a repeat procedure. For example, if a different physician acquires additional images, interprets, and prepares a report in addition to the preoperative TEE, then (image acquisition, interp/report) or (congenital image acquisition, interp/report) can be reported with modifier -77. This indicates that the additional image acquisition and interpretation was provided by a different physician. The medical record should reflect the medical necessity for repeating these procedures. {D DOCX / 1 }May ASE Coding and Reimbursement Newsletter A Membership Benefit- Copyright American Medical Association. All rights reserved. is a registered trademark of the American Medical Association. 22