MEDAC BILLING & COMPLIANCE ALERT
PA Catheter Rebill Potential for Additional Revenues

By: Bellinger P. Moody, RHIA, CPC, CCP
Executive Vice President of Compliance

Due to a recent increase in the Practice Expense Relative Value Units (PE RVUs) assigned to CPT code 93503 -- Insertion and placement of flow directed catheter (e.g., Swan-Ganz) -- when performed in the facility setting, you may be able to get additional reimbursement for all PA catheters billed in the facility setting, effective October 5, 2009.

The American Society of Anesthesiologists (ASA) posted the following message on its website (www.asahq.org) on September 3, 2009, under the “What’s New?” section:

“CMS issued an October Update to the 2009 Medicare Physician Fee Schedule Database. This update includes an increase in the Practice Expense Relative Value Units (PE RVUs) assigned to CPT® code 93503 – Insertion and placement of flow directed catheter (e.g., Swan-Ganz) for monitoring purposes. – when performed in a facility setting. CMS determines payment for this and other non-anesthesia services using the Resource Based Relative Value System (RBRVS) under which RVUs are assigned for work, practice expense and professional liability. These values are geographically adjusted and the resulting sum is multiplied by a conversion factor that remains constant.

The PE RVUs for code 93503 will increase from 0.00 to 0.75 RVUs.  Before geographic adjustments are factored in, these additional PE RVUS will result in an increase in payment of approximately $27.05 (0.75 * $36.07).  Per CMS, the change will be implemented on Oct. 5 and will be effective for services provided on and after January 1, 2009. Per the CMS Transmittal, contractors will not be required to review their files and retroactively pay past claims, but are instructed that they shall adjust claims brought to their attention”.

We will be running reports on these codes and will resubmit them through Medicare's redetermination unit for additional reimbursement.  We will provide you with an estimation of the additional revenues you can expect once we have analyzed the reporting data after October 5th.

For complete information see:

CMS Medlearn Matters notice: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6617.pdf

CMS Transmittal 1810: http://www.cms.hhs.gov/Transmittals/downloads/R1810CP.pd

The information presented herein reflects general information that is current as of the date it is first published.  In light of changes that may occur in the health care regulatory and compliance environments, the author's presentation of this information and any general advice previously published might become outdated.  Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.