Practices that perform in-office echocardiography
services will likely be negatively affected by the 2009 Medicare
Physician Fee Schedule, although the impact will vary greatly
depending on the mix of services provided.
In 2009 physicians will use a new CPT code, 93306, to report
transthoracic echocardiography with spectral and color flow
Doppler echocardiography. Echocardiographers previously reported
this study with a combination of three CPT codes (93307, 93320,
and 93325). Transthoracic echocardiography without spectral
or color flow Doppler will continue to be reported with 93307
and 93320 and 93325 remain available as add-on codes for echocardiography
services other than 93307. In addition, physician practices
that provide both the echocardiography and stress test components
of a stress echocardiography study will no longer report those
components separately, but will use a new combined code (93351).
The combination of the revised practice expense formula,
the shift of the budget neutrality adjustment from the work
RVUs to the conversion factor, and combining separate codes
into the new bundled codes results in significant payment
cuts for these key echocardiography studies. The national
average payment for transthoracic echocardiography with spectral
and color flow Doppler echocardiography will decrease from
$356 in 2008 to $268 in 2009 – a 25% cut, while payment
for stress echocardiography with stress EKG will drop 10%
from $302 in 2008 to $272 in 2009.
The new bundled codes for echocardiography result from intense
pressure by the Centers for Medicare & Medicaid Services
(CMS), Medicare Payment Advisory Commission and other policymakers
to move toward combining codes for services frequently performed
together. This initiative is fueled by the belief that the
payment rates that result from having separate codes for services
frequently performed together are too high and do not account
for efficiencies in physician work and practice expense. CMS
has made clear its intention to unilaterally to reduce payments
if specialty societies do not act to create new bundled CPT
codes, which the ACC has responded to by proactively developing
new codes. For example, the cardiology community’s efforts
in 2007 to dissuade CMS from discontinuing any payment for
color flow Doppler echocardiography only succeeded because
the ACC and the American Society for Echocardiography had
initiated the process to establish the new bundled code.
The January edition of Cardiology will include a
special pull-out section on new CPT codes for 2009, including
the new echocardiography codes as well as new and revised
codes for cardiac device monitoring services.
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