Health Information Management

Q&A: Why are our cardiology department reimbursements down in 2014?

APCs Insider, March 7, 2014

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Q: Our cardiology department is currently reviewing its January revenue report. We are seeing an increase in lack of payment for many of our services that received payment in the past. For example, our cardiac nuclear stress tests have some components that are no longer being reimbursed. Our business office says that this is correct. What’s going on?
A: CMS greatly expanded the packaging under the OPPS for CY 2014. Using claims data from CY 2012, CMS looked at services that are provided together on a regular basis, including cardiac stress tests and the multiple components. The claims data revealed that when a cardiac stress test with myocardial perfusion is performed, CPT® codes 93017 (cardiovascular stress test; tracing only) and 78452 (myocardial perfusion imaging; multiple studies) are reported together on a majority of claims.
For CY 2014, CMS has assigned CPT 93017 to status indicator Q1 (S, T, V, X packaged service), while CPT 78452 is assigned to status indicator S (significant service). When CPT 93017 is reported with 78452, the payment for 93017 is packaged into 78452. So the payment for the stress test is packaged into the myocardial perfusion imaging study.
In addition, CMS unconditionally packaged the four stress agents (adenosine, dipyridamole, dobutamine, and regadenoson [Lexiscan®]) into the myocardial perfusion study as well.
In the event that a new stress agent is introduced and eligible for transitional pass-through status, the agent would be reimbursed separately, but CMS will establish a device offset that will be subtracted from the APC payment.
Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

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