American College of Cardiology

2008 Hospital Outpatient Prospective Payment System
The Centers for Medicare & Medicaid Services (CMS) finalized bundling payments for seven categories in with the APC payment in the 2008 final Hospital Outpatient Perspective Payment System (HOPPS) rule. All diagnostic radiopharmaceuticals, contrast agents and many imaging add-on codes are now bundled with the cost of the major procedure CPT codes. These services are shown as having status indicator “N,” which indicates that the item or service payment is packaged in with another service.

It is important to remember that items and services labeled with status indicator “N” are still considered paid by CMS. The costs of these status “N” services were and will be used by CMS to set the final payment rates and are included in the 2008 and future APC major procedure payments. All coders and billers (charge master managers) should remember to follow HIPAA standards and report all services performed, even those with status indicator “N.” For example, a nuclear cardiologist who performs an MPI SPECT, single study with wall motion should include the study CPT procedure code (78464), as well as the add-on CPT procedure code (78478), including the radiopharmaceutical HCPCS Level II specific code on the UB04 claim form prior to submitting it to CMS.

Balloon Catheters Recalled
Johnson & Johnson's Cordis unit has recalled approximately "132,000 balloon catheters used to expand blood vessels after it was determined problems with the devices could cause injury or death." According to Cortis, there have been no reported deaths thus far as a result of the problems. The balloons do not deflate properly, and could potentially cause heart attack or death. The recall does not affect the 'Cypher' drug-coated stent heart device, as the stent isn't delivered on these balloons."

SPECT MPI Appropriateness Criteria Decision Support Tool Released
A SPECT MPI Appropriateness Criteria decision support application was released this week to help guide clinicians in the ordering of SPECT MPI. The tool is designed to help avoid time-consuming pre-certification for inappropriate patient indications and to help more easily calculate patient cardiovascular risk or pre-test probability. The decision support tool is based on the 2005 ACC/ASNC Appropriateness Criteria and was developed in partnership with Skyscape. The application contains three quick and easy tools to help guide test ordering.

• Symptomatic Patient -- Pre-Test Probability Appropriateness Calculator
• Asymptomatic Patient -- Framingham Risk Appropriateness Calculator
• Perioperative patients, patients with prior imaging test results, patients with known CAD, post revascularization patients – Appropriateness Algorithm

ACC members are encouraged to use this application in their own practice and raise awareness among their referral base of this important tool. You can download this application at :

WinCE :
http://www.skyscape.com/download/reseller.asp?format=binary&os=win&device=ce&product=spectmpi

Palm/Windows :
http://www.skyscape.com/download/reseller.asp?format=binary&os=win&device=palm&product=spectmpi

Palm/Mac :
http://www.skyscape.com/download/reseller.asp?format=binary&os=mac&device=palm&product=spectmpi

Windows Desktop:
http://www.skyscape.com/download/reseller.asp?format=binary&os=win&device=pc&product=spectmpi

CMS PQRI Web Site Updated
The Centers for Medicare & Medicaid Services (CMS) has announced that the Physician Quality Reporting Initiative (PQRI) Web site has been reorganized to facilitate access and navigation to 2008 PQRI information and educational resources, including a 2008 PQRI Tool Kit. Key documents related to 2008 measure specifications have been retained and placed as downloadable documents within their corresponding sections. In addition, new documents that further inform eligible providers about 2008 PQRI have been added. Information about the 2007 PQRI program, which ended on Dec. 31, 2007, has also been reorganized with relevant documents pertaining to 2007 measures retained for reference. For more information, visit: http://www.cms.hhs.gov/PQRI/.

Performance Assessment: Bring It On!
In the January issue of Cardiology magazine, we asked you "what makes a quality cardiologist." Your comments on the following questions will help guide the ACC as it attempts to answer this question.

As a cardiovascular professional, what items would you choose to publish on a ‘report card’ to demonstrate your excellence to a prospective patient?

Now, you need a cardiologist and CANNOT consult a medical colleague. What information would be valuable to help you choose?

Go to http://lewinreport.acc.org and join the discussion.