SCAI - The Society for Cardiovascular Angiography and ...



March 4, 2020Cathy Cook, M.D.Medical DirectorNational Correct Coding InitiativeCapitol Bridge, LLCP.O. Box 368Pittsboro, IN 46167-0368Dear Dr. Cook,The Society for Cardiovascular Angiography and Interventions (SCAI) is a non- profit professional association with over 4,500 members representing interventional cardiologists and cardiac catheterization including pediatric interventional cardiologists treating patients with congenital heart disease. SCAI promotes excellence in interventional cardiovascular medicine through education, representation and the advancement of quality standards to enhance patient care. The American College of Cardiology (ACC) envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its more than 54,000 members is to transform cardiovascular care and to improve heart health for all. SCAI and ACC would like to request a review of several edits that are causing concern among our pediatric cardiologists.It has been brought to our attention that numerous NCCI edits have historically caused our members to be paid inadequately for procedures/services performed. NCCI, a body created by the centers for Medicare and Medicaid services to promote national correct coding methodologies and control improper coding, as standard practice, uses Medicare utilization data in support of its determinations. Unfortunately, the work performed by the pediatric interventional community is not captured by any utilization data available to NCCI. Due to the lack of dedicated CPT? codes to capture the significant differences in work this community performs, they have been relegated to borrowing codes from the non-congenital (adult) cardiology community, interventional radiology, and others. Edits issued for codes in these sections of CPT codes have an inadvertent harmful effect on the pediatric interventional community. As an example, we bring to NCCI’s attention, a recent edit which precluded the use of CPT code 33210 (Insertion of a temporary transvenous single chamber pacing catheter) at the same setting as cardiac catheterization. It has been argued by NCCI that procedure 33210 was intended to be a stand-alone procedure. However, this should not prevent a provider from performing one stand-alone procedure at the same setting as another. In the congenital catheterization population, procedure 33210 is performed during certain congenital cardiac interventions, such as when having to rapid pace the heart to reduce cardiac output during balloon angioplasty for treatment of coarctation of the aorta. This procedure involves obtaining left heart (arterial) access and extending a large balloon which is inflated in the aorta to treat the lesion. In doing so, the balloon can often move up and down the aorta significantly with the pulsatility of blood flow. Rapidly pacing the heart reduces the cardiac output, and therefore the pulse pressure, allowing the balloon to remain stable in position and allow for a safe intervention. The pacing catheter is inserted by obtaining venous access, advancing the pacing catheter into the heart, and performing tests by pacing at progressively faster heart rate until the desired drop in blood pressure is achieved. ?These interventions are typically during procedures that require arterial access for repair of coarctation of the aorta or aortic balloon valvuloplasty, and the work captured by CPT 33210 is entirely distinct from any necessary on the left heart for the interventions. SCAI recently reached out to NCCI in a letter dated April 10, 2019 (attached), with another significant issue regarding MUE edits for CPT code 75827 (venography, caval superior). Evidence for the existence of a persistent left sided superior vena cava in the congenital cardiac defect population was explained to NCCI in our request for allowing the existing CPT code to be used to capture this very unique work by allowing for an MUE of 2 for this code. The response we received was once again quoting Medicare utilization data, or the lack thereof, in its justification for the denial of our request. We would like to request a change to the NCCI edits so that when medical necessity dictates our members would be able to bill CPT code 33210 with cardiac catheterizations. We would also be available to hold a conference call between NCCI officials and our CPT/RUC advisors and staff, to discuss these difficulties in an effort to come up with a resolution as well as discuss possible processes to avoid such future inadvertent events. Please feel free to reach out to our staff if you have any questions. SCAI, Wayne Powell at wpowell@ and for ACC, Debra Mariani at dmariani@.Sincerely,Arthur C. Lee, MDRandall C. Thompson, MD, FACCSCAI, CPT AdvisorACC CPT Advisor ................
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