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Frank,
Sorry I was in a bit of a hurry yesterday. You are correct my point does go
a little bit further. As our reimbursements decrease (see APC reductions to
2006 for coinsurance) I feel it is imperative to assail the Gatekeepers of
the Medicare Program from every legal option so we are not put out of
existence. I genuinely feel that left on their we would be obliterated by
other specialty groups. Our specialty is very small in comparison to
Radiology, Cardiology and the rest of the budget. As you, above anyone else
would know, if not for some Herculean efforts by you and Dale Asplund we
could have been buried already. I am seeing signs of eminent peril again. As
I understand from Bill Sarraille the Lewin Group has discovered, with your
and Dr. Zwolak's help, that they have admitted a mistake was made in
calculating the RVU's for noninvasive vascular. It was his opinion to me
that even though they saw an error they were not going to do very much to
fix it. Correspondingly when the APC's were first published and the inequity
with echocardiolgraphy was discussed (again this was related to me by Bill)
the HCFA response was that echo was more difficult and they were not going
to change the APC for vascular. As you know we have also lost some codes to
bundling.
As I understand it you participated in some of these meetings, so you would
know better than I if my fears are warranted. Nevertheless, I have this
really bad feeling that unless some sort of movement is instituted we will
find ourselves in jeopardy. As you are well aware if I have to take this
fight on myself I will, but I do miss you.
Robert T Kane
Phoenix Cardiovascular
Doylestown PA
----- Original Message -----
From: "Franklin W. West" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, February 05, 2001 6:11 PM
Subject: 93325


> Bob,
>
> I'm uncertain regarding your point.  You are correct in noting the current
> definition of 93325 is specific to echocardiography and you are correct in
> noting that CPT is in no way limited by the specialty of the provider (in
> fact, you may have been present at the meeting where a HCFA representative
> noted that any psychiatrist would be paid for the performance of cardiac
> transplant under the program - medical licensure being unlimited and a
> states rights issue).  I don't believe that I suggested anything that
would
> violate either of these facts.
>
> However, given the current definition of 93325 is specific to
> echocardiography, the use of this code in other than cardiac evaluations
> would appear to be inappropriate in my opinion.  I understand that this
was
> historically not the case, but it has been since 1/1/99.  Personally, my
> admittedly low risk-tolerance level would not allow my use of this code to
> describe what I do when performing non-cardiac duplex scanning and I would
> find it analogous to billing for 93307 and/or 93320 (also echocardiography
> CPT codes) on non-cardiac cases.  That is, I would not care to be in a
> position of having to defend to an Assistant US Attorney the use of
cardiac
> ultrasound CPT codes when not used to evaluate the heart.  Somehow, the
"but
> they've got a code" argument seems more than a little weak, and not
material
> to the point.  But then, that may not have been your point ...
>
> *************************************************
> Franklin W. West
> [log in to unmask]
> *************************************************
>
> -----Original Message-----
>  Sent: Saturday, February 03, 2001 10:54 AM
>  Subject: Re: venous insufficiency
>
> Frank,
> As you have mentioned in your communication CCI does not bundle color flow
> and our vascular duplex scans anymore. The new CPT code definition is
> Doppler echocardiography color flow velocity mapping (List separately in
> addition to codes for echocardiography). Some would get the impression
that
> you could not bill this code with a duplex vascular study. However, if you
> read the Instructions for Use of CPT paragraph 2 " It is important to
> recognize that the listing of a service or procedure and its code number
in
> a specific section of this book does not restrict its use to a specific
> specialty group. Any procedure or service in any section of this book may
be
> used to designate the services rendered by any qualified physician."
> Robert T Kane
> Phoenix Cardiovascular
> Doylestown PA
> ----- Original Message -----
>  Sent: Friday, February 02, 2001 9:08 AM
> Subject: Re: venous insufficiency
>
> > Dwight,
> >
> > With the advent of HOPPS, the Correct Coding Initiative now applies to
> > Intermediaries (has for some time impacted the Part B side).  On the
down
> > side, it bundles a large number of procedures.  On the up side, it did
> away
> > with local edits.  Given CCI does not bundle 93325 (color) with either
> 93320
> > (Doppler) or 93327 (B-mode), under the Medicare Program, you do get paid
> for
> > color when performing an echocardiography.  A previous CCI edit did
bundle
> > 93325 with duplex scan codes, but this was removed a number of years ago
> and
> > the AMA CPT Editorial Panel revised the definition of 93325 to be
specific
> > to echocardiography, thus making it unnecessary to bundle with the
duplex
> > scan codes.  If a Medicare Intermediary is denying claims based on a
local
> > edit, I would suggest you (1) appeal and (2) notify you local HCFA
> Regional
> > Office.
> >
> > *************************************************
> > Franklin W. West
> > [log in to unmask]
> > *************************************************
> >
> > -----Original Message-----
> > From: [log in to unmask]
> [mailto:[log in to unmask]]On
> > Behalf Of Michael, Dwight
> >
> > Bonnie,
> >   Don't rush to judgement on the echocardiography folks.  While
> > reimbursement is better for echo, those of us who run combined
> echo/vascular
> > labs see similar problems with both modalities.  Many intermediaries
will
> > deny payment for Color Flow Doppler on an echocardiogram if the patient
> also
> > had a vascular duplex exam on the same day.  Since color flow is bundled
> > into the vascular charge, they say that you are billing for the same
> > modality twice on the same patient, even though it is two totally
> unrelated
> > uses of color flow.  Additionally, if a patient has an echocardiogram
> > performed, the physician then determines that the patient needs a stress
> > echo, you can only bill for one or the other and not both. Since resting
> > wall motion images must be obtained for the stress echo, it is assumed
> > (inaccurately) that this constitutes a complete resting echocardiogram.
> >   However, you are quite correct regarding the inequity of reimbursement
> > between the two disciplines (echo & vascular).  Vascular studies are
more
> > "tedious" and therefore take longer to perform.  Some would argue that
> > vascular requires a higher level of "skill" to obtain quality images.  I
> do
> > both.  Therefore I choose to NOT get into that discussion. The two
> > modalities are just different.  Both require a high level of knowledge
and
> > skill and the learning curve continues on forever, (if you want to be
> good).
> >
> > Dwight Michael, RDCS, RVT
> > Dirctor, Non-Invasive Cardiovascular Services
> > Birmingham Baptist Medical Center-Montclair
> > -----Original Message-----
> >
> > Ahhhhhh! We all feel your pain. Sorry pal but it's the same pay for the
> same
> > CPT code. To make matters worse the CPT code is the same for the upper
> > extremity as it is for the lower so can't bill for both those either.
Bet
> > echocardiology does not have this gross inequity in their unbundled
> > codes!!!!!!!!! (don't get me started) More for our governmental
relations
> > people at SVT, SVS, ISCVS, SDMS etc etc etc to be working on. bj
> >
> > Bonnie L. Johnson RDMS, RVT, FSVT
> <snip>