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Efforts by ACC, ASE Result in Reversal of Problematic Coding Changes by McKesson

Updated June 2012

Thanks to the hard work of the ACC and American Society of Echocardiography (ASE) over the past year and a half, McKesson Health Solutions has agreed to reverse its decision to implement claims coding edits that deny separate payment for echocardiogram interpretations when performed on the same date of service as an inpatient evaluation and management (E/M) visit. These edits, which are contained in software marketed by McKesson, have been adopted by a number of private payers including Aetna, Horizon BCBS of New Jersey, BCBS of Illinois, and others.
Following a series of letters and conversations between ACC, ASE and McKesson, the company has agreed to remove edits, recognizing that the problems associated with implementing the changes outweigh the benefits.  In a letter issued Aug. 15, 2012, McKesson states that changes will be effective starting between Oct. 1, 2012, and Jan. 1, 2013, depending on the software system. McKesson has begun communicating this change to its insurer clients and ACC and ASE members can attach this letter to any affected claim appeal submissions. The ACC and ASE continue to recommend that cardiovascular professionals continue to bill these procedures with the most appropriate modifier.

Stay tuned to www.CardioSource.org and The ACC Advocate, and follow @Cardiology on Twitter to keep up on the latest developments.