CMS Rescinds Oct. 1, 2007 Changes to NCCI Policy Manual for Medicare Services Version 13.3, Chapter V, Paragraph 16, Regarding Coding for Angioplasty, Atherectomy and Stent Placement

“CMS will temporarily rescind the new paragraph and replace it with the one originally published in 1996 which states:
           
“When percutaneous angioplasty of a vascular lesion is followed at the same session by a percutaneous or open atherectomy, generally due to insufficient improvement in vascular flow with angioplasty alone, only the most comprehensive atherectomy that was performed (generally the open procedure) is reported (see sequential procedure policy, Chapter I, Section M).”

This change will be retroactive to October 1, 2007.  The original paragraph will appear in version 14.3 of the Manual scheduled for publication on October 1, 2008.  The change will also occur in the online version of the Manual published on the CMS website as early as possible.”

The letter from CMS can be read in its entirety by following this link.

The coding policies in effect prior to the release of version 13.3 of the NCCI manual can immediately be followed.  As with any retroactive change, you may consider reviewing prior billed cases which occurred during this time period.  Keep in mind there are still well-established criteria for determining when and if a separate intervention is reportable.  Please refer to the established guidelines from our 2007 code book for coding angioplasty, atherectomy and vascular stent placement in the non-coronary arteries and veins.  We will be posting an update to our 2008 books as soon as possible.

We thank Stacy Gregory, RCC, CPC for sharing this information with us so that we can inform all of you.  Please see her contact information on the above letter.We are very pleased with this CMS guideline change and will keep you posted as more information is available.