Need Your Help to Establish Reimbursement for Category III Echocardiographic CPT™ Codes

Coding accurately for the services you provide is essential, especially in today’s environment when you are facing declining reimbursement and increased scrutiny. ASE is committed to ensuring you are fairly reimbursed for your work. In this effort, the Society was able to establish two new Category III echocardiographic CPT™ codes and encourages you to use them when appropriate.

While category III codes are not reimbursed by the Centers for Medicare and Medicaid Services (CMS), these codes are sometimes reimbursed by private payers. ASE is meeting with private payers in an effort to establish reimbursement. Additionally, CMS will track submission of these codes. There will be an opportunity for this code to progress to Category I status over the next few years based on 1) utilization and 2) additional peer reviewed publications demonstrating efficacy.

CPT™ code +0399TMyocardial strain imaging has emerged as a sensitive tool for assessing regional and global left ventricular systolic function. +0399T is to be reported once per encounter in addition to the appropriate echocardiography base codes 93303-93351.

CPT™ code +0439T: Myocardial contrast perfusion echocardiography imaging code aids in the detection of myocardial ischemia and myocardial viability and is well-tolerated and safe in both ambulatory and critically ill patients. This code should be submitted whenever myocardial contrast perfusion echocardiography is performed but may be used only in conjunction with echocardiography base codes 93306, 93307, 93308, 93350, 93351.

There is a time frame for utilization. If the codes are not used they may “sunset” after five years, eliminating the opportunity to establish reimbursement and limiting patients’ access to the technology. Therefore, ASE is encouraging you to share information about these new codes with your lab staff and business departments and submit these codes whenever myocardial strain imaging or myocardial perfusion echocardiography is performed.

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Urgent Call to Action – Support ASE Representation on Vital Issues by Joining the AMA!

ASE is working hard to ensure your voice is heard on issues related to legislative matters, regulatory issues, coding and reimbursement. To do so, ASE must maintain the Society’s seat in the American Medical Association (AMA) House of Delegates. To qualify, 25% of ASE’s U.S. physician members must also be members of the AMA.

As a member of the House of Delegates ASE:

  • Helps sets the legislative and regulatory priorities for the AMA.
  • Has full delegate status which provides ASE with full representation before CPT/RUC.
    • This has contributed to some of ASE’s more recent, substantial advocacy successes.

For more detailed information please read: The ABC’s of Payment for Cardiovascular Ultrasound Services and Why the AMA Matters .

To help ASE reach this critical goal click here.

We urge you to join the AMA today to help us ensure that echo has a voice!

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How to Review Your QRUR and PQRS Reports Before the December 1st Deadline

2016 Physician Quality Reporting System (PQRS) feedback reports and 2016 Annual Quality and Resource Use Reports (QRURs) were released on September 18, 2017. Dr. Geoffrey Rose, an ASE Board and Advocacy Committee member, developed a brief presentation on these reports to help ASE members understand what they are, how they impact you, and how to read them.

These reports will determine whether providers are subject to the 2018 PQRS downward payment adjustment and your practice’s 2018 Value Modifier payment adjustment. If you believe information contained in these reports is incorrect, you may request an informal review of your 2016 PQRS results and/or 2018 Value Modifier calculation during the informal review period from now until December 1, 2017 8:00 PM Eastern Time (ET).

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2018 MPFS AND HOPPS Proposed Rules

ASE is working on a detailed and targeted analysis of the CY 2018 Medicare Physician Fee Schedule (MPFS) Proposed Rule and the Hospital Outpatient Prospective Payment System (HOPPS) Proposed Rule. ASE will issue comments to the CMS once these proposals have been thoroughly evaluated. Comments from the healthcare community on both proposed rules will be accepted by CMS until September 11, 2017.  Learn more here.

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Value of Echo Summit

In case you missed that ASE sponsored a Value of Echo Summit during our 2017 ASE Scientific Sessions, we are making the presentations available to everyone interested in this topic. The session was intended to help provide some understanding of the U.S. healthcare system as it undergoes a significant transformation from fee-for-service to value-based healthcare and developing new alternative payment models (APMs). The summit was divided into two sessions. The first session focused on understanding the impending changes to the overall healthcare system and the impact to you. The second session featured experts identifying the best strategies and practices to ensure you maximize all opportunities and thrive in this challenging environment.

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Documentation of Moderate Sedation

With regard to documentation of moderate sedation, beginning January 1, 2017, we would suggest documenting the duration of moderate sedation services. Intraservice time should be documented based on the specific number of minutes, as opposed to a range of time, to meet all payer requirements. Please note that the moderate sedation intraservice time will likely be different than the intraservice time of the underlying procedure. If the physician does not document his/her intraservice time or if the time is less than 10 minutes, the service is not reportable.

For more detailed information on billing please go to: http://connect.asecho.org/communities/community-home/digestviewer/viewthread?MessageKey=712b52af-a838-44c8-83de-da8e4a8595b8&CommunityKey=f2171f48-b144-4e72-a2cb-a1df0e9d768d&tab=digestviewer

Please let us know if you have any additional questions.  Also, please keep us posted on the claims process, we would be interested to know how they adjudicate.

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CMS Delays Expansion of Bundled Payment Programs

On Monday, CMS announced that they will delay expansion of the Comprehensive Care for Joint Replacement bundle and its bundled payment initiatives for cardiac care bundled payment programs. The effective date is being moved from July 1, 2017 to October 1, 2017. Learn more here.

In other Advocacy related news, you can also download a document related to the Trump Administration’s Blueprint Budget for Fiscal Year 2018 with highlights of the healthcare related provisions.

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Updated ASE’s 2017 Coding Newsletter Now Available

CMS issued some corrections to the HOPPS final rule. It included minor changes to some of the APCs that will impact some rates. ASE has updated the Annual Coding Newsletter to reflect these changes.

Also available are ASE’s coding webinar and a document to assist you in billing echo-specific information on moderate (conscious) sedation in conjunction with TEE. You must now bill it separately. Payment for moderate sedation is no longer included in the allowances for any TEE codes. If moderate sedation codes are not separately reported, payment for the service will be lost.

Please visit ASE’s Coding and Reimbursement and MACRA web pages to help you understand the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) and how to comply with the Merit-Based Incentive Payment System (MIPS).

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Do You Need Help Understanding MACRA?

Geoffrey A. Rose, MD, FASE, presented a webinar to help the cardiovascular ultrasound community understand how to comply with the Merit-Based Incentive Payment System (MIPS), one of the two payment tracks being created under the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) to reform Medicare payment. It is expected that over 90 percent of all physicians will need to comply with MIPS to avoid facing penalties. The webinar delves into the details of this complex program and  outlines practical steps for you to achieve  ‘MACRA-readiness.’

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CMS Releases the CY 2017 HOPPS and PFS Final Rules

Yesterday, the Centers for Medicare and Medicaid Services (CMS) released the CY 2017 HOPPS final rule. A complete copy of the rule is now available.

This afternoon, CMS released its 2017 Medicare Physician Fee Schedule final rule. This final rule addresses changes to the physician fee schedule and other Medicare Part B payment policies.

ASE will be analyzing these policies, and a more detailed and targeted analysis will be available soon.

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ECHOVATION SUBMISSION DEADLINE EXTENDED! If you have an innovative solution to improve cardiovascular ultrasound, it’s not too late to submit your idea for a chance to share in the $10,000 prize money! Visit https://herox.com/echovation-challenge-2018 to find out what’s required, register as an innovator, and submit your proposal 11:59 PM ET on February 23!