As of Jan. 1, substantial changes occurred in the coding for three commonly used services — myocardial perfusion/SPECT imaging, coronary CT angiography (CTA) and cardiac MRI.
SPECT Imaging
CMS's continued pressure to bundle together imaging services reported with multiple codes has now hit myocardial perfusion imaging. In 2010, myocardial perfusion imaging / SPECT studies, including wall motion and ejection fraction, will be reported with a single code (78452). Multiple study SPECT imaging has typically been reported using three codes: 78465 to report the heart imaging, and two add-on codes, 78478 for wall motion study and 78480 for ejection fraction. Similarly, codes for a single SPECT study and planar studies have been created that bundle wall motion and ejection fraction codes. Even if a SPECT or planar study is performed without these additional studies, they should still be reported with these new codes as the old codes have been deleted.
CMS decided to substantially reduce the payment for myocardial perfusion imaging as part of its final rule by reducing both the physician work value and the practice expense value. As a result, the Medicare payment rates for myocardial perfusion imaging have decreased by 30-40 percent from the payments for the combined codes in 2009.
Coronary CTA
The codes for coronary CTA have also changed for 2010. Although coronary CTA in the past was reported using eight different Category III codes, in 2010, these codes have been replaced with four Category I codes. Because of this, it is important to review the service provided to determine which code is most appropriate.
The changes for coronary CTA codes are as follows:
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75571 now is used to report evaluation of coronary calcium, which was previously reported as 0144T
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75572 replaces 0145T for CT, heart, without contrast/with contrast and further sections
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75573 replaces 0150T for a CTA performed in a patient with known or suspected congenital heart disease
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75574 now is used for a CTA performed in a non-congenital case, replacing codes 0146T-0149T
While use of coronary CTA has grown substantially in the past five years, it was carrier-priced by region prior to 2010. This means that the impact of these changes on payment will be different depending on which state the service is provided in.
Cardiac MRI
The reporting structure for cardiac MRI codes changed slightly in 2010. As a result of the reporting change, four codes were deleted and a new add-on code created. Services previously reported with 75558, 75560, 75556, and 75564, which all included velocity flow mapping, now should be reported with the appropriate code from 75557-75563 with an add-on code, 75565, to report the velocity flow mapping.
Next Steps for Practices
With these changes in effect, practices need to work with their health plans to accurately implement and crosswalk the 2009 codes to the new 2010 codes so processing goes smoothly. Practices should also negotiate with health plans to avoid tying future private payer rates to Medicare rates, as Medicare rates for certain services will decrease over coming years. The ACC has developed tips and resources for navigating these changes.
UPDATE: CMS did issue technical corrections to the 2010 Medicare Physician Fee Schedule this past spring. The correction notice resulted in payment increases for myocardial perfusion imaging (MPI) codes, cardiac CT codes, and cardiac catheterization codes, retroactive to Jan. 1, 2010. The correction notice also includes a minor increase in the Medicare conversion factor (from 36.066 to 36. 0791) effective June through December 2010. Read the ACC's overview of the corrections.