Sergio Bartakian MD FSCAI FAAP Pediatric and Congenital Interventional Cardiologist Childrens Hospital of Michigan DMC AMA CPT RUC Advisor SCAI Disclosures None Roadmap Structure Representation lack of ID: 1039154
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1. CPT Coding for CHD CatheterizationsSergio Bartakian, MD, FSCAI, FAAPPediatric and Congenital Interventional CardiologistChildren’s Hospital of Michigan, DMCAMA CPT / RUC Advisor, SCAI
2. DisclosuresNone
3. RoadmapStructureRepresentation / lack ofCommon problems / solutionsLooking ForwardRUC Surveys
4. AMA CPT Advisory CommitteeTotal number of advisors: 156Panel members: 20Number of pediatric cardiologists: that have any experience with cardiac catheterization of CHD 1Job of the CPT simply stated - Create the codes and maintain the code set
5. CPT Advisor RepresentationNational 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)
6. Relative value scale Update CommitteeRUC committee31 members – mostly specialistsDescribe the work involved for a given code and establish an RVU recommendationRecommendations are passed on to CMS for formal acceptance 12 of 31 panel members representing surgical specialties1 Pediatrician (AAP)
7. CV Surgical CPT CodesCPT2000201733875 (DAO graft)33.0650.7253%33641 (ASD)21.3929.5838%33681 (VSD)27.6732.3417%33870 (TAO graft)40.3146.0614%33697 (TOF)33.7137.5711%33670 (AVSD)32.7336.6312%33611 (DORV)32.3035.5710%33506 (ALCAPA)26.7137.8542%33533 (CAB)25.8333.7531%33534 (CAB2)28.8239.8838%33535 (CAB3)31.8144.7541%+335172.573.6140%+335184.857.9364%33430 (MVR)31.4350.9362%33475 (PVR)28.4142.4049%Average 35% increase
8. Interventional CPT CodesCPT2000201793530 (RHC)4.233.97(-6%)93531 (R/LHC)8.358.3493565 (RV)0.860.8693568 (PA)0.880.8892992 (BAS)0037242 (Embol)10.05 (2014)9.80(-2.5%)93580 (ASD)18.00 (2003)17.9737236 (Stent)9.0 (2014)8.75(-3%)92990 (P Vplasty)17.3418.275%
9. 2017 CPT ChangeOpen and percutaneous transluminal angioplasty code deletions / replacements201635472 – Transluminal balloon angioplasty, aortic 75966 – Transluminal balloon angioplasty, RS&I36200 - Introduction catheter AO35472 (6.9 RVU) + 75966 (1.31 RVU) + 36200 (2.77 RVU) = 10.97 RVU201737246 – transluminal balloon angioplasty, 1st artery - All inclusive37246 – 7 RVU (instant 36% reduction)
10. 2016-17 CPT ChangeACR - American College or RadiologySIR - Society of Interventional RadiologySVS - Society for Vascular Surgery
11. Who Does CMS Ask?N = 9331, 37242
12. 93580, N = 1683
13. So, What Can We Do?Step 1: Build a CoalitionSCAIACCASEHRSSIRACRSVSSTSThe House of CardiologySupport from Radiology and Surgical Colleagues
14. So What Can We Do?Step 2: Formed PICCWMyself, 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
15. So What Are We Doing?Step 3Identified the problems to be addressedBalloon atrial septostomy New congenital cardiac cath codesPulmonary artery stentingDuctal stentingAtrial septal / Fontan fenestration stentingCoarctation angioplasty / stentingPA angiography with device closure bundlesModifier 63LSVC angiographyIntracardiac pacing with interventionsICE3D PrintingPulmonary arterial and venous angiographyTrans-hepatic accessRF/wire revascularlization (RF perforation of PV/PA)Cardiac cath with biopsiesPericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use nowThermodilution – received significantly improved values, will be able to use with new base codesPICC Line Placement - Stopped effort to eliminate ultrasound use
16. Timeline for a new code
17. Multi-Pronged AttackCoding NeedsNCCINew Code ApplicationsCPT Assistant ArticlesEditorial Revisions
18. Identified the problems to be addressedBalloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21New congenital cardiac cath codesPulmonary artery stentingDuctal stentingAtrial septal / Fontan fenestration stentingCoarctation angioplasty / stentingPA angiography with device closure bundlesModifier 63LSVC angiographyIntracardiac pacing with interventionsICE3D PrintingPulmonary arterial and venous angiographyTrans-hepatic accessRF/wire revascularlization (RF perforation of PV/PA)Cardiac cath with biopsiesPericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use nowThermodilution – received significantly improved values, will be able to use with new base codesPICC Line Placement - Stopped effort to eliminate ultrasound use
19. Identified the problems to be addressedBalloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21New congenital cardiac cath codes – Presenting this weekPulmonary artery stentingDuctal stentingAtrial septal / Fontan fenestration stenting Coarctation angioplasty / stentingPA angiography with device closure bundlesModifier 63LSVC angiographyIntracardiac pacing with interventionsICE3D PrintingPulmonary arterial and venous angiographyTrans-hepatic accessRF/wire revascularlization (RF perforation of PV/PA)Cardiac cath with biopsiesPericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use nowThermodilution – received significantly improved values, will be able to use with new base codesPICC Line Placement - Stopped effort to eliminate ultrasound use
20. Identified the problems to be addressedBalloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21New congenital cardiac cath codes – Presenting this weekPulmonary artery stentingDuctal stentingAtrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21Coarctation angioplasty / stentingPA angiography with device closure bundlesModifier 63LSVC angiographyIntracardiac pacing with interventionsICE3D PrintingPulmonary arterial and venous angiographyTrans-hepatic accessRF/wire revascularlization (RF perforation of PV/PA)Cardiac cath with biopsiesPericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use nowThermodilution – received significantly improved values, will be able to use with new base codesPICC Line Placement - Stopped effort to eliminate ultrasound use
21. Identified the problems to be addressedBalloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21New congenital cardiac cath codes – Presenting this weekPulmonary artery stentingDuctal stentingAtrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21Coarctation angioplasty / stentingPA angiography with device closure bundles – Resolved 2019Modifier 63LSVC angiographyIntracardiac pacing with interventionsICE3D PrintingPulmonary arterial and venous angiographyTrans-hepatic accessRF/wire revascularlization (RF perforation of PV/PA)Cardiac cath with biopsiesPericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use nowThermodilution – received significantly improved values, will be able to use with new base codesPICC Line Placement - Stopped effort to eliminate ultrasound use
22. Identified the problems to be addressedBalloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21New congenital cardiac cath codes – Presenting this weekPulmonary artery stentingDuctal stentingAtrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21Coarctation angioplasty / stentingPA angiography with device closure bundles – Resolved 2019Modifier 63 – Complete. Available 1/1/2020LSVC angiographyIntracardiac pacing with interventionsICE3D PrintingPulmonary arterial and venous angiographyTrans-hepatic accessRF/wire revascularlization (RF perforation of PV/PA)Cardiac cath with biopsiesPericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use nowThermodilution – received significantly improved values, will be able to use with new base codesPICC Line Placement - Stopped effort to eliminate ultrasound use
23. Identified the problems to be addressedBalloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21New congenital cardiac cath codes – Presenting this weekPulmonary artery stentingDuctal stentingAtrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21Coarctation angioplasty / stentingPA angiography with device closure bundles – Resolved 2019Modifier 63 – Complete. Available 1/1/2020LSVC angiography – Appeal letter submitted to CMS / NCCIIntracardiac pacing with interventionsICE3D PrintingPulmonary arterial and venous angiographyTrans-hepatic accessRF/wire revascularlization (RF perforation of PV/PA)Cardiac cath with biopsiesPericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use nowThermodilution – received significantly improved values, will be able to use with new base codesPICC Line Placement - Stopped effort to eliminate ultrasound use
24. Identified the problems to be addressedBalloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21New congenital cardiac cath codes – Presenting this weekPulmonary artery stentingDuctal stentingAtrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21Coarctation angioplasty / stentingPA angiography with device closure bundles – Resolved 2019Modifier 63 – Complete. Available 1/1/2020LSVC angiography – Appeal letter submitted to CMS / NCCIIntracardiac pacing with interventions – Appeal letter submitted to CMS / NCCIICE3D printing Pulmonary arterial and venous angiographyTrans-hepatic accessRF/wire revascularlization (RF perforation of PV/PA)Cardiac cath with biopsiesPericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use nowThermodilution – received significantly improved values, will be able to use with new base codesPICC Line Placement - Stopped effort to eliminate ultrasound use
25. Identified the problems to be addressedBalloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21New congenital cardiac cath codes – Presenting this weekPulmonary artery stentingDuctal stentingAtrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21Coarctation angioplasty / stentingPA angiography with device closure bundles – Resolved 2019Modifier 63 – Complete. Available 1/1/2020LSVC angiography – Appeal letter submitted to CMS / NCCIIntracardiac pacing with interventions – Appeal letter submitted to CMS / NCCIICE – presenting this week3D printing Pulmonary arterial and venous angiographyTrans-hepatic accessRF/wire revascularlization (RF perforation of PV/PA)Cardiac cath with biopsiesPericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use nowThermodilution – received significantly improved values, will be able to use with new base codesPICC Line Placement - Stopped effort to eliminate ultrasound use
26. Identified the problems to be addressedBalloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21New congenital cardiac cath codes – Presenting this weekPulmonary artery stentingDuctal stentingAtrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21Coarctation angioplasty / stentingPA angiography with device closure bundles – Resolved 2019Modifier 63 – Complete. Available 1/1/2020LSVC angiography – Appeal letter submitted to CMS / NCCIIntracardiac pacing with interventions – Appeal letter submitted to CMS / NCCIICE – presenting this week3D printing - category 3 CPT code issued 2019Pulmonary arterial and venous angiographyTrans-hepatic accessRF/wire revascularlization (RF perforation of PV/PA)Cardiac cath with biopsiesPericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use nowThermodilution – received significantly improved values, will be able to use with new base codesPICC Line Placement - Stopped effort to eliminate ultrasound use
27. Identified the problems to be addressedBalloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21New congenital cardiac cath codes – Presenting this weekPulmonary artery stentingDuctal stentingAtrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21Coarctation angioplasty / stentingPA angiography with device closure bundles – Resolved 2019Modifier 63 – Complete. Available 1/1/2020LSVC angiography – Appeal letter submitted to CMS / NCCIIntracardiac pacing with interventions – Appeal letter submitted to CMS / NCCIICE – presenting this week3D printing - category 3 CPT code issued 2019Pulmonary arterial and venous angiographyTrans-hepatic accessRF/wire revascularlization (RF perforation of PV/PA)Cardiac cath with biopsiesPericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use nowThermodilution – received significantly improved values, will be able to use with new base codesPICC Line Placement - Stopped effort to eliminate ultrasound use
28. Identified the problems to be addressedBalloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21New congenital cardiac cath codes – Presenting this weekPulmonary artery stenting Ductal stentingAtrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21Coarctation angioplasty / stentingPA angiography with device closure bundles – Resolved 2019Modifier 63 – Complete. Available 1/1/2020LSVC angiography – Appeal letter submitted to CMS / NCCIIntracardiac pacing with interventions – Appeal letter submitted to CMS / NCCIICE – presenting this week3D printing - category 3 CPT code issued 2019Pulmonary arterial and venous angiographyTrans-hepatic accessRF/wire revascularlization (RF perforation of PV/PA)Cardiac cath with biopsiesPericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use nowThermodilution – received significantly improved values, will be able to use with new base codesPICC Line Placement - Stopped effort to eliminate ultrasound useDrafted
29. Identified the problems to be addressedBalloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21New congenital cardiac cath codes – Presenting this weekPulmonary artery stenting Ductal stentingAtrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21Coarctation angioplasty / stenting – To be presented October 2020 PA angiography with device closure bundles – Resolved 2019Modifier 63 – Complete. Available 1/1/2020LSVC angiography – Appeal letter submitted to CMS / NCCIIntracardiac pacing with interventions – Appeal letter submitted to CMS / NCCIICE – presenting this week3D printing - category 3 CPT code issued 2019Pulmonary arterial and venous angiographyTrans-hepatic accessRF/wire revascularlization (RF perforation of PV/PA)Cardiac cath with biopsiesPericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use nowThermodilution – received significantly improved values, will be able to use with new base codesPICC Line Placement - Stopped effort to eliminate ultrasound useDrafted
30. Identified the problems to be addressedBalloon atrial septostomy - New code created 2019, valued 2020, Available 1/1/21New congenital cardiac cath codes – Presenting this weekPulmonary artery stenting Ductal stentingAtrial septal / Fontan fenestration stenting – Created 2019, valued 2020, Available 1/1/21Coarctation angioplasty / stenting – To be presented October 2020 PA angiography with device closure bundles – Resolved 2019Modifier 63 – Complete. Available 1/1/2020LSVC angiography – Appeal letter submitted to CMS / NCCIIntracardiac pacing with interventions – Appeal letter submitted to CMS / NCCIICE – presenting this week3D printing - category 3 CPT code issued 2019Pulmonary arterial and venous angiography – To be presented October 2020Trans-hepatic accessRF/wire revascularlization (RF perforation of PV/PA)Cardiac cath with biopsiesPericardiocentesis – old codes deleted by CMS. New codes created, accepted, and in use nowThermodilution – received significantly improved values, will be able to use with new base codesPICC Line Placement - Stopped effort to eliminate ultrasound useDrafted
31. Why these problems occurLack of involvementNo representation = gradual reduction without a fightIe, Pericardiocentesis and PICC linesLack of understandingCoders and panel members: Catheterization ≠ catheterizationOur own community: Poor RUC survey responsesLack of existenceIn the adult world, pediatrics does not existData is derived from CMS (Medicare) utilizationExamples provided: COA, LSVC, PICC lines
32. What can YOU do?Respond to surveysAsk questionsQuestion and audit your coders - they are NOT the experts!Learn the RUC survey process
33. The RUC SurveyPre, Intra, and Post procedurePlease refer to CCT articles published in April and May for more detailThe survey will ask you to state how much time and intensity it takes you to perform the procedureVITAL that your responses pertain to the “typical patient” and work description described in the vignette, NOT YOUR TYPICAL.If you are not familiar with such a patient, you should not respond to the survey at all.
34. ExampleYou are asked to complete a survey on PDA closure, the vignette describes a typical 2 y/o PDA procedure.In your practice, a new Preemie PDA device closure is performed in 30% of total cases, whereas 70% continue to be the standard varietyAlthough the intensity of the new preemie PDA may be somewhat higher, the overall time is typically less.Because >50% of all PDA device closure cases nationally are done using standard technique (same as your practice), you base your survey responses only on cases done with the standard technique, NOT an average of all cases.This is an example of why it is vital to read the vignette and understand which population to consider before answering time / intensity questions. Ie, whether the vignette describes a 1-year-old PDA device procedure, vs a 1-week-old premature infant.
35. Determining what is the “typical” caseYour typical population for a given procedure may be different than the code proposalInstitutional preferences for surgical repair of complex casesReferral patterns different than other centersAnswer based on the typical case described, if you are familiar with such a case, even if that is not typical for you in generalTake into account all of the steps included in the description (bundling)Eg, angiograms, imaging, other interventions, etcDo not assume the new code is a 1:1 replacement for the existing codeIe, if a new ASD code was proposed, make sure to review what is included in the new code vs what was included previously. Add / remove time for any changes
36. Thank you