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New Codes for Cardiac CT
The American Medical Association's Current Procedural Terminology (CPT) panel has approved four new Category 1 codes for cardiac computed tomography, which replace current Category III codes. The new codes were the result of a joint effort by professional societies including the American College of Radiology and the Society of Cardiovascular Computed Tomography. The codes will go into effect Jan. 1, 2010. They are 75571 (calcium scoring), 75572 (pulmonary veins), 75573 (congenital heart disease), and 75574 (coronary CT angiography). Both relative value units for physician reimbursement and the payment rates for hospitals probably will be established this month. “This accomplishment represents a significant step forward to achieve broader patient access to this proven technology,” the society said in a statement.
Combination to Face New Rules
The Food and Drug Administration is proposing new postmarketing reporting requirements for products that are combinations of drugs, devices, and biologics. According to the FDA, a combination product can include a drug or biologic combined with a device, a biologic and a drug combined, or all three together. Combinations may be physically or chemically mixed, packaged together, or two separate products intended for use together. Until now, the agency acknowledged, there has been a “lack of regulatory clarity,” so many adverse events may not be reported, or are reported in ways that are difficult for the agency to track. The FDA published its proposal in the Oct. 1 Federal Register and is accepting comments until Dec. 30.
CMS Weighing Evidence on MRA
The Centers for Medicare and Medicaid Services has begun an analysis to determine whether Medicare should begin covering magnetic resonance angiography nationally. The agency said that its “blanket noncoverage of MRA for blood flow determination … is no longer supported by the available evidence.” Local contractors can decide whether to cover MRA while CMS studies the potential for national coverage. The agency was accepting comments through Nov. 6, and it expects to issue a proposed decision in early April 2010.
HHS Eyeing Imaging Pay
Some time during the fiscal year that began Oct. 1, the Department of Health and Human Services' Office of Inspector General will start reviewing Medicare's Part B payments to physicians for imaging services. The focus will include “the physician professional cost component, malpractice costs, and practice expense,” according to the OIG. For each service, staff will determine whether the payment “reflects the actual expenses incurred and whether the utilization rate reflects current industry practices.” The agency also said it would investigate diagnostic x-rays that are performed in emergency departments. Imaging there has increased, said the OIG, and in 2007 cost Medicare about $207 million in physician payments. While the report on imaging in emergency departments is due within the year, the overall imaging report probably will not be completed until FY2011, said the OIG.
Flat Growth for Imaging?
A new analysis by the Access to Medical Imaging Coalition claims that in 2008, physician use of imaging services expanded modestly for the second year in a row. The analysis—done for the coalition by the Moran Company—found that the use of CT, magnetic resonance imaging, positron emission tomography, and nuclear services grew by 1.1%, down from the 1.9% increase in 2007. There was even a decline in the use of screening mammography, according to the study. Mammography grew 0.15% in 2007, but fell off 0.20% in 2008. Dual-energy absorptiometry scans also declined by 0.4%, compared with 2007. “Contrary to the assumption that advanced imaging spending is rapidly increasing, the 2008 data appear to confirm the deceleration of imaging cost growth first observed in the 2007 data,” Don Moran, the company's president, said in a statement. A statement from the imaging coalition said that the Deficit Reduction Act of 2005 has had a huge impact on utilization, and that policy makers should take that into account when considering imaging reimbursement cuts.
Practice Revenues Decline
Medical practice revenues have fallen, possibly because of declining patient volumes and lower payments from people in financial hardship, according to the Medical Group Management Association. Medical practices responded by trimming overhead costs more than 1%, but that wasn't enough to offset shrinking revenues, the MGMA found in its 2009 practice cost survey. Multispecialty group practices saw a 1.9% decline in total medical revenue from 2008, with substantial drops in both the number of procedures and the number of patients. Bad debt in multispecialty group practices from fee-for-service charges increased 13% from 2006 to 2008.