CPT Coding for CHD Catheterizations Sergio Bartakian, MD, FSCAI, FAAP Pediatric and Congenital Interventional Cardiologist Children’s Hospital of Michigan, DMC AMA CPT / RUC Advisor, SCAI Disclosures None Roadmap • Structure • Representation / lack of • Common problems / solutions • Looking Forward • RUC Surveys AMA CPT Advisory Committee • Total number of advisors: 156 • Panel members: 20 • Number of pediatric cardiologists: that have any experience with cardiac catheterization of CHD 1 • Job of the CPT simply stated - Create the codes and maintain the code set CPT Advisor Representation • National Association of Social Workers (1) • American Podiatric Medical Association (2) • National Athletic Trainers Association (2) • American Massage Therapy Association (2) • American Academy of Dermatology (2) • American College of Mohs Surgery (1) • American Society of Aesthetic Plastic Surgery, Inc. (1) • American Society for Dermatologic Surgery (2) • Society of Investigative Dermatology (1) • American Academy of Pediatrics – representing ALL SPECIALTIES (2) Relative value scale Update Committee • RUC committee • 31 members – mostly specialists • Describe the work involved for a given code and establish an RVU recommendation • Recommendations are passed on to CMS for formal acceptance 12 of 31 panel members representing surgical specialties 1 Pediatrician (AAP) CV Surgical CPT Codes CPT 2000 2017 33875 (DAO graft) 33.06 50.72 53% 33641 (ASD) 21.39 29.58 38% 33681 (VSD) 27.67 32.34 17% 33870 (TAO graft) 40.31 46.06 14% 33697 (TOF) 33.71 37.57 11% 33670 (AVSD) 32.73 36.63 12% 33611 (DORV) 32.30 35.57 10% 33506 (ALCAPA) 26.71 37.85 42% 33533 (CAB) 25.83 33.75 31% 33534 (CAB2) 28.82 39.88 38% 33535 (CAB3) 31.81 44.75 41% +33517 2.57 3.61 40% +33518 4.85 7.93 64% 33430 (MVR) 31.43 50.93 62% 33475 (PVR) 28.41 42.40 49% Average 35% increase Interventional CPT Codes CPT 2000 2017 93530 (RHC) 4.23 3.97 (-6%) 93531 (R/LHC) 8.35 8.34 93565 (RV) 0.86 0.86 93568 (PA) 0.88 0.88 92992 (BAS) 0 0 37242 (Embol) 10.05 (2014) 9.80 (-2.5%) 93580 (ASD) 18.00 (2003) 17.97 37236 (Stent) 9.0 (2014) 8.75 (-3%) 92990 (P Vplasty) 17.34 18.27 5% 2017 CPT Change • Open and percutaneous transluminal angioplasty code deletions / replacements • 2016 • 35472 – Transluminal balloon angioplasty, aortic • 75966 – Transluminal balloon angioplasty, RS&I • 36200 - Introduction catheter AO • 35472 (6.9 RVU) + 75966 (1.31 RVU) + 36200 (2.77 RVU) = 10.97 RVU • 2017 • 37246 – transluminal balloon angioplasty, 1st artery - All inclusive • 37246 – 7 RVU (instant 36% reduction) 2016-17 CPT Change ACR - American College or Radiology SIR - Society of Interventional Radiology SVS - Society for Vascular Surgery Who Does CMS Ask? N = 9331, 37242 93580, N = 1683 So, What Can We Do? Step 1: Build a Coalition • SCAI • ACC The House of Cardiology • ASE • HRS • SIR • ACR Support from Radiology and • SVS Surgical Colleagues • STS So What Can We Do? • Step 2: Formed PICCW • Myself, Drs. Zahid Amin, Shawn Batlivala, Jeff Delaney, Guru Hiremath, Mark Hoyer, Frank Ing, Jeremy Ringewald, Bob Vincent, SCAI staff (Dawn Gray – up to 2020) Wayne Powell • Identified the problems to be addressed • Balloon atrial septostomy • New congenital cardiac cath codes So What Are We Doing? • Pulmonary artery stenting • Ductal stenting Step 3 • Atrial septal / Fontan fenestration stenting • Coarctation angioplasty / stenting • PA angiography with device closure bundles • Modifier 63 • LSVC angiography • Intracardiac pacing with interventions • ICE • 3D Printing • Pulmonary arterial and venous angiography • Trans-hepatic access • RF/wire revascularlization (RF perforation of PV/PA) • Cardiac cath with biopsies • Pericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use now • Thermodilution – received significantly improved values, will be able to use with new base codes • PICC Line Placement - Stopped effort to eliminate ultrasound use Timeline for a new code May 2020 Recommended RVUs CMS issues draft rule Decision for a new code forwarded to CMS summer 2021 made today June 30, 2020 Deadline for prepared January 2021 CMS issues final rule application to be RUC Meeting November 2021 submitted Nov 2020 October 2020 January 1, 2022 Application presented at (IF passes at CPT) Code available for use in CPT meeting RUC Survey goes out CPT book Multi-Pronged Attack CPT New Code Assistant Applications Articles Coding Needs NCCI Editorial Revisions • Identified the problems to be addressed • Balloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21 • New congenital cardiac cath codes • Pulmonary artery stenting • Ductal stenting • Atrial septal / Fontan fenestration stenting • Coarctation angioplasty / stenting • PA angiography with device closure bundles • Modifier 63 • LSVC angiography • Intracardiac pacing with interventions • ICE • 3D Printing • Pulmonary arterial and venous angiography • Trans-hepatic access • RF/wire revascularlization (RF perforation of PV/PA) • Cardiac cath with biopsies • Pericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use now • Thermodilution – received significantly improved values, will be able to use with new base codes • PICC Line Placement - Stopped effort to eliminate ultrasound use • Identified the problems to be addressed • Balloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21 • New congenital cardiac cath codes – Presenting this week • Pulmonary artery stenting • Ductal stenting • Atrial septal / Fontan fenestration stenting • Coarctation angioplasty / stenting • PA angiography with device closure bundles • Modifier 63 • LSVC angiography • Intracardiac pacing with interventions • ICE • 3D Printing • Pulmonary arterial and venous angiography • Trans-hepatic access • RF/wire revascularlization (RF perforation of PV/PA) • Cardiac cath with biopsies • Pericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use now • Thermodilution – received significantly improved values, will be able to use with new base codes • PICC Line Placement - Stopped effort to eliminate ultrasound use • Identified the problems to be addressed • Balloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21 • New congenital cardiac cath codes – Presenting this week • Pulmonary artery stenting • Ductal stenting • Atrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21 • Coarctation angioplasty / stenting • PA angiography with device closure bundles • Modifier 63 • LSVC angiography • Intracardiac pacing with interventions • ICE • 3D Printing • Pulmonary arterial and venous angiography • Trans-hepatic access • RF/wire revascularlization (RF perforation of PV/PA) • Cardiac cath with biopsies • Pericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use now • Thermodilution – received significantly improved values, will be able to use with new base codes • PICC Line Placement - Stopped effort to eliminate ultrasound use • Identified the problems to be addressed • Balloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21 • New congenital cardiac cath codes – Presenting this week • Pulmonary artery stenting • Ductal stenting • Atrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21 • Coarctation angioplasty / stenting • PA angiography with device closure bundles – Resolved 2019 • Modifier 63 • LSVC angiography • Intracardiac pacing with interventions • ICE • 3D Printing • Pulmonary arterial and venous angiography • Trans-hepatic access • RF/wire revascularlization (RF perforation of PV/PA) • Cardiac cath with biopsies • Pericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use now • Thermodilution – received significantly improved values, will be able to use with new base codes • PICC Line Placement - Stopped effort to eliminate ultrasound use • Identified the problems to be addressed • Balloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21 • New congenital cardiac cath codes – Presenting this week • Pulmonary artery stenting • Ductal stenting • Atrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21 • Coarctation angioplasty / stenting • PA angiography with device closure bundles – Resolved 2019 • Modifier 63 – Complete. Available 1/1/2020 • LSVC angiography • Intracardiac pacing with interventions • ICE • 3D Printing • Pulmonary arterial and venous angiography • Trans-hepatic access • RF/wire revascularlization (RF perforation of PV/PA) • Cardiac cath with biopsies • Pericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use now • Thermodilution – received significantly improved values, will be able to use with new base codes • PICC Line Placement - Stopped effort to eliminate ultrasound use • Identified the problems to be addressed • Balloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21 • New congenital cardiac cath codes – Presenting this week • Pulmonary artery stenting • Ductal stenting • Atrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21 • Coarctation angioplasty / stenting • PA angiography with device closure bundles – Resolved 2019 • Modifier 63 – Complete. Available 1/1/2020 • LSVC angiography – Appeal letter submitted to CMS / NCCI • Intracardiac pacing with interventions • ICE • 3D Printing • Pulmonary arterial and venous angiography • Trans-hepatic