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Resources for your practice.
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Indiana-ACC Cardiology
Coding Seminar
April 28, 2010 Indianapolis, IN
Get the brochure and register.
Problems
with the new Nuclear Cardiology Codes?
Effective January 1, 2010,
the billing for myocardial perfusion imaging (SPECT and planar) has changed. Practices must use CPT® codes (78451-78454)
to report these procedures. Is your practice using the new codes and having problems with getting paid or receiving
correct reimbursement for your nuclear cardiology studies? If you are having difficulties or questions, please let us know
at the ACC Payer Hassle Factor Form. New Nuclear
Cardiology codes: What you should know - Insurer contracts: Provisions in your insurer contracts that may
affect reimbursement
1.
Is there language in the contract that governs the fee schedule? Is this language linked to a specific year?
2.
Does the contract incorporate CMS changes automatically? 3. Is reimbursement tied to Work
RVUs only, or are practice expenses and practice liability insurance also included? 4.
Does the contract require advance notice for fee schedule changes? For more tips for reviewing your provider contracts, please visit
the MPI Coding: Assessing the Current Situation Page.
New! Practice
Survival Toolkit
The ACC has created a practice survival toolkit in response to the unjustified and unprecedented
cuts to cardiology in the 2010 Physician Fee Schedule. The toolkit includes an expansive array of information and resources.
Topics range from simple advice such as collecting co-payments at the time of service to options for future business plans.
The toolkit aims to allow the survival of the practice of cardiology in the U.S. so that cardiovascular professionals can
continue to deliver the reductions in mortality and the improved quality of life unique to the specialty. View the Practice Survival Toolkit.
Participate in the new PINNACLE Network™Participate
in the new PINNACLE Network™. This first-ever, registry-based cardiovascular network is designed to provide practices
with the tools they need to promote practice innovations and achieve clinical excellence. Learn more.
Anthem Blue Cross Blue Shield implemented a new echocardiography
pre-notification and pre-authorization program. Click here for the information sheet about the plan. The ACC and ASE sent a joint letter to WellPoint, Anthem's parent company, Executive Vice President and Chief Medical
Officer, Samuel Nussbaum, MD, requesting a suspension for the insurer's announced echo pre-notification and results reporting
program until a reasonable and viable alterative can be reached. The medical groups expressed concern about the major
distruption these programs will cause to medical practices. They also conveyed that the program is misdirected to penalize
all echo providers rather than the inadqueately trained and test duplicators. Click here for the full text of the letter. Please send your own letters in support of the ACC/ASE position. Address your letters to:
Samuel R. Nussbaum, M.D.Executive Vice President, Clinical Health Policyand
Chief Medical OfficerWellPoint, Inc.120 Monument CircleIndianapolis,
IN 46204
ACC staff also met with the Blue Cross Blue Shield
Association. The meeting focused on major concerns and iniaitives of national medical specialty societies such as the ACC.
The outcome of the meeting will be the convening of several workgroups that will focus on the following: 1) Prior Authorization
alternatives and standardization; 2) The role of the specialist in the Patient Centered Medical Home; and 3) Physician recognition
programs. The BCBSA also noted they will assist ACC and ASNC in communications surrounding the new nuclear codes to member
plans to avoid payment delays in 2010.
Why not include information about CardioSmart
on your practice website? Learn how. 
Coding
Alert: NCCI Corrects Echo "Add on" Codes
On April 1, 2009, the National Correct Coding
Initiative (NCCI) removed its restriction on billing the echocardiography "add-on" codes (CPT 93320 and 93325) together.
The NCCI accepted the ACC recommendation to retroactively remove the coding edit and permit medical providers to bill these
codes with the appropriate echocardiography CPT code during the same visit on the same day. It should be noted that 93307 should not be reported with 93320 and 93325. Instead, use
93306, since it includes both add-on codes (93320 and 93325). The add-on codes should not be billed separately. This
correction became effective Jan. 1. 93307 - Transthoracic (2D) echocardiography without spectral or color Doppler.
93306 - Transthoracic
(2D) echocardiography with spectral Doppler and color flow Doppler + 93320 - Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately
in addition to code for echocardiographic imaging); complete
+ 93325 - Doppler echocardiography color flow velocity mapping
(List separately in addition to code for echocardiographic imaging)
The College advises
its members and office practices to resubmit any claims on or after Jan. 1, 2009 denied for using both CPT 93320 and 93325
together. For more information about coding changes for 2009, see the ACC 2009 Guide to Cardiology Coding and Payment Changes. Also, the “Cardiovascular Coding 2009: Practical Reporting of Cardiovascular Services and Procedures” guide is now available for purchase.
CIGNA Revises
Modifier (-25 and -59) Policy
CIGNA changed its policy to require providers to submit supporting documentation for any claims with
procedures and services that are appended with a CPT modifier 25 or 59. As of April 20, 2009, CIGNA
planned to require documentation for approximately 17,000 NCCI code pairs. After listening
to numerous providers and professional medical societies including the American College of Cardiology and the AMA, CIGNA has
decided to significantly reducing the number of NCCI code pairs for which it requires documentation to fewer than 500 (less
than 5 percent of CIGNA's total claims). CIGNA will delay full implementation of this program until April
27, 2009.
CIGNA
will also provide helpful hints to ensure the supporting documentation physicians submit via fax or mail for these NCCI code
pairs contains the appropriate information to successfully match the documentation with the electronic claim submission. In
the meantime, please instruct physicians and their practice staff to check Box 19/Loop 3200 on their claim submission to indicate
that they submitted supporting documentation. Supporting documentation can be faxed to CIGNA at (570) 496-2945 or sent via mail to the CIGNA address on the back of the patient’s
ID card.
Here are
some important instructions for your practice: As of April 20: - CIGNA was
pleased to report the mandatory submission of documentation for NCCI code pairs appended with CPT modifier 59 will be delayed
until April 27, 2009. Beginning April 27, the list of code combinations that require supporting documentation for modifier
59 will be significantly reduced.
- Documentation submission requirements for NCCI code pair edits appended with
CPT modifier 25 will be active through April 24. Physicians and their practice staff must choose to either
submit these code pairs with documentation or postpone submission to the following week. Physicians and their
practice staff should remember to always appropriately document the performance of procedures and services prior to submitting
a claim. Beginning April 27, the list of code combinations that require supporting documentation for modifier 25 will also
be significantly reduced.
Once
the revised list is released, the ACC will highlight the code pairs most frequently billed by cardiologists.
Please instruct your practice staff to keep visiting www.cignaforhcp.com for the revised list of which NCCI code pairs that will
require supporting documentation with the claims submission when appended with a CPT modifier 25 or 59. For the complete list
of current code combinations that require supporting documentation when modifiers 25 or 59 are billed, log in to the secure
CIGNA for Health Care Professionals Web site (www.cignaforhcp.com) and select “Resources” then “Claim Editing Procedures.” The
updated code combination lists will be available online prior to April 27.
Physicians who are not currently registered for the CIGNA for Health Care Professionals Web site will
need to complete the registration process to log on. They can go to www.cignaforhcp.com and select “Register Now,” located
in the left side bar.
The ACC has posted tools in its Issue Resource Center on Medicare Payment Reform. Now available on this page is information on claims-based participation in the Physician Quality Reporting Initiative, including
frequently-asked questions and a cardiology worksheet, as well as information on the new Centers for Medicare and Medicaid
Services e-prescribing incentive program. Visit the Medicare payment resource center to learn more! The
Geographic Practice Cost Index (GPCI) Medicare is statutorily required to adjust payments for physician fee schedule services to account for differences
in costs due to geographic location. There are currently 89 different localities which have not been revised since 1997. Medicare
has been looking into revising GPCI system for several years, but has not finalized any proposals. CMS contracted a consulting
firm to study alternative GPCI systems and released a interim study at:
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