Cardiologists, cardiac surgeons push insurance company to rethink billing policy
The American College of Cardiology (ACC), Society for Cardiovascular Angiography and Interventions (SCAI) and Society of Thoracic Surgeons (STS) are calling on a health insurance company based out of Spokane, Washington, to rethink one of its billing policies for transcatheter heart procedures.
The three groups wrote a letter to Asuris Northwest Health about its coding recommendations for valve-in-valve transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVR) procedures. Currently, the insurance company asks providers to use 33999, an unlisted CPT code, for these procedures. The groups, however, do not believe this accurately measures the amount of work being provided by the care team.
“ACC, SCAI and STS would like to point out that the work associated with a valve-in-valve procedure is virtually identical to the work involved in the native valve TAVR (33361-33366) and TMVR (33418-33419) procedures and believe that it is more appropriate to use the TAVR or TMVR CPT codes for these procedures,” the groups wrote. “In cases where the valve-in-valve procedure makes the case more complex, such as when bioprosthetic valve fracture is performed, we recommend that the TAVR or TMVR CPT code should be billed with a -22 modifier to indicate the additional complexity. We therefore respectfully request that you change your coding guidance regarding coding for these procedures.”
The letter was addressed to Asuris Northwest Health President Brady Cass and signed by ACC President B. Hadley Wilson, MD; SCAI President George Dangas, MD, PhD; and STS President Thomas E. MacGillivray, MD.
Read the full letter as a PDF here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.