Sergio Bartakian, MD, FSCAI, FAAP; Sarosh Batlivala, MD, MSCI; Gurumurthy Hiremath, MD, FACC, FSCAI; Frank Ing, MD, FACC, MSCAI
In the initial three articles of this series, we focused primarily on the components of the physicians’ description of work and briefly touched on the RUC survey. These were important as part of the effort to educate the Congenital Cardiology community on the importance of CPT® coding and the RUC valuation for their work. The majority of the work of the CICCW, however, has been focused on the creation of a comprehensive congenital cardiac catheterization code set. Previously, a simplistic set of diagnostic codes had been created with the bulk of the work performed being captured by codes borrowed from other specialties: namely, non-congenital cardiac catheterization and interventional radiology. This left many procedures without an appropriate code resulting in the lack of any reimbursement for many complex interventions. Whereas these borrowed codes may have served their purpose early on in the era of predominantly diagnostic catheterization, they fail miserably in capturing the complexity of patients in a specialty that has seen dramatic changes over the past 2-3 decades. In fact, the field continues to transform every year, with ongoing advancements in imaging technology, catheterization equipment, and interventional devices.
FIGURE 1 Timeline for a new CPT® code
The process of creating of a new code is not straightforward. The timeline is quite lengthy and even in the absence of any delays, will require at least 20 months from start to finish (Figure 1).
Creating a new code for each and every item for which we have a need is, therefore, a significantly time-consuming and ineffective plan. Alternatively, there are other pathways through which resolution could be achieved for some problems (Figure 2).
Editorial revisions are also processed through the same CPT® pathway and are essentially suggestions for corrections or changes to an existing item in the CPT® book. These can often be expedited (somewhat), as they typically do not need to go through the RUC process. The CICCW used this pathway to correct an error regarding the ability to report a pulmonary angiogram (93568) at the time of a PDA device closure procedure (93582).
To read the full article, please go to the November 2020 Issue of CCT.