3:00 p.m. BREAK

3:20 p.m. Is Carotid Stenting Supported by Data?

TBD

3:30 p.m. Results of European Trials

Klaus D. Mathias, MD Teaching Hospital oj the City oj Dortmund

Dortmund, Germany

3:40 p.m. SAPPIllRE Trial: One-Year Results

Jay Yadav, MD The Cleveland Clinic Foundation

Cleveland, OH

3:50 p.m. ARCHER Trial: One-Month Results

Mark H. W'holey, MD

Pittsburgh Vascular Institute

Pittsburgh, PA

4:00 p.m.

Update on High Risk Registries

Barry T Katzen, MD Miami Cardiac & Vascular Institute

Miami, FL

4:10 p.m. Developing a Carotid Stent Program in a

Community Hospital

Rodney D. Raabe, MD Sacred Heart Medical Center

Spokane, W'A

4:20 p.m.

Coding and Billing Issues Katharine L. ](1'01, MD St. Vincent Hospital Indianapolis, IN

Current Status

This syllabus contribution was due Sept 30, 2003 (prior to the annual meeting in Phoenix in March 2004, when the presentation will be given). It is anticipated that there will be significant change in carotid stent coding and reimbursement by the second quarter of 2004, and those changes will be presented in a more up-to-date form at the annual meeting.

As of 9/30/2003, carotid stenting is not covered by Medicare except in CMS-approved FDA-approved clini­cal trials. The coding and reimbursement for those trials is determined by each local carrier, since there is not a national payment policy for this procedure. For non­Medicare carriers, some do cover these procedures, and it is imperative to talk with each carrier to determine coverage and payment policy. Some secondary carriers

will cover carotid stenting even when not covered by the

primary Medicare policy. Most secondary carriers will follow the Medicare payment policy.

FOr coding carotid stenting, the following options

exist: 1. Level III CPT codes

0005T: stenting of brachiocephalic vessel , initial vessel 0006T: stenting of brachiocephalic vessel, each addl.

vessel 0007T: stenting of brachiocephalic vessel, each ves­

sel, RS&I 2. Unlisted procedure code

e.g., 37799: unlisted vascular procedure

3. Existing Category I CPT codes 37205: non-coronary vascular stent placement,

initial vessel 37206: non-coronary vascular stent placement,

each addl. vessel 75960: non-covonary vascular stent placement,

RS&I 36215, 36216, 36217, 36218: selective catheteriza­

tion codes as appropriate for catheterization(s)

performed to accomplish the procedure 35475: brachiocephaic artery PTA

75962: arterial PTA, RS&J

For options 1 and 2, use of these codes may be required by the carrier, but the codes do not have any inherenr work valuation. They may be reimbursable, but the amount needs to be negotiated with the carrier. Sending in a bill for code 0005T will result in a payment of $0.00

unless it is discussed with the carrier, allOWing them to determine what is being done and how much it is worth.

For options 1 and 2, some carriers may choose to use one or two codes to describe the entire procedure, taking a bundled approach for dle procedure rather than using component codes. This is acceptable, but the phy­sician needs to have input with the valuation to assure that the work of all the components of work being done are included in the ultimate valuation.

For option 3, Medicare has required that a PTA is charged since they have nor had the ability to cover the facility side of the procedure without dle PTA charge (there is not an appropriate stent facility payment cate­gory) . This has led to some difficulty in patients where a balloon was not used to pre-dilate the lesion or post­dilate the lesion, based on technical factors.

In Medicare patients requiring this procedure who are not covered, hospitals are more frequently requiring the patients to sign an Advanced BenefiCiary Notice (ABN), notifying the patient the Medicare will not pay for the procedure and requiring the patient to be responsi­ble for the entire bill for the hospitalization (if the carotid stent procedure is the reason for the hospitalization). My personal experience is that the hospital quotes the pa­tient $15,000-$20,000 estimate. If the physician wishes to charge the patienr for the procedure as well, a separate Advanced Beneficiary Notice (ABN) must be presented

P29