Final Rule Includes Phased-In Cuts for Cardiology
The Centers for Medicare and Medicaid Services (CMS) on Friday released its 2010 Medicare Physician Fee Schedule final rule, which includes policies that significantly reduce payments for cardiovascular-related services. While CMS has attempted to mitigate the impacts of the cuts by spreading them out over a four-year period, the impact of the cuts is still enormous both for 2010 and beyond. Cuts of this magnitude—whether enacted this year or spread over four—cannot be absorbed and we will continue to fight the implementation of this data until a rigorous review is conducted.

The ACC understands the very real impacts these cuts will have on your practices, your staff and your patients. The College is exploring all options and staff and leaders are working together to help you understand all of your options. Click here for a high-level summary of the policy proposals included in the rule. More information over the coming weeks will be provided in ACC blogs, The Lewin Report, Cardiology magazine, ACC News and The ACC Advocate. Please also plan to join ACC CEO Jack Lewin and President Alfred Bove, M.D., F.A.C.C., for an all-member call on Nov. 12 from 4:00 to 5:30 p.m. (EST) to discuss the 2010 rule. To RSVP for the call, click here.

More Changes to Coding in 2010
Substantial changes in coding will occur in 2010 for three commonly used services – myocardial perfusion/SPECT imaging; coronary CT angiography (CTA); and cardiac MRI. Beginning in 2010, four new Category 1 CPT codes are being created for coronary CTA, replacing the previously used eight Category III codes. For cardiac MRI, services previously reported with 7558, 75560, 7556, and 75564, which all included velocity flow mapping, now should be reported with the code from 7557-75563 with an additional add-on code, 75565, to report the velocity flow mapping.

In addition, a new code (78452) has been created to combine the three codes (78465, 78478, 78480) typically reported for multiple study SPECT imaging. Similarly, codes for a single SPECT study and planar studies have been created that bundle wall motion and ejection fraction codes. Medicare has reduced the payment for these services by 36 percent with the release of the final 2010 Medicare Physician Fee Schedule. The ACC is fighting to prevent these from being implemented and is working with local chapters and cardiovascular specialty societies to assist carriers in updating their coverage policies. The College also is asking health plans to maintain reimbursement rates at 2009 levels. More information will be available in the November issue of Cardiology.

FTC Delays Red Flags Rules Again
The Federal Trade Commission (FTC) has even further delayed implementation of new rules aimed at preventing identity theft until June 1, 2010. The ACC, the American Medical Association (AMA), Medical Group Management Association (MGMA) and other medical associations have challenged the rules’ inclusion of physicians as “creditors” because they regularly defer payment for goods and services. The FTC released rules in November 2007 requiring all financial institutions and “creditors” to develop and implement a written program to protect consumers by identifying potentially suspicious “red flags” that may signal identity theft. The ACC is taking advantage of this newest reprieve to continue efforts to have physicians removed from the creditor definition.

In the meantime, the ACC recommends that practices begin preparing a written identity theft detection and prevention program that complies with the new rules as a contingency plan. The AMA, MedAxiom and MGMA have developed Red Flags Rule guidance documents and sample policies that can be modified. The FTC also has developed a template that groups at low risk can use to develop their programs, available on its Web site.

FDA News Updates
The Food & Drug Administration (FDA) has made labeling changes to the diabetes drug exenatide (Byetta), following 78 reports of kidney function program, including renal failure, in patients treated with the drug between April 2005 and October 2008. The problems tended to occur in patients with one or more risk factors for kidney problems or who had pre-existing kidney disease. Health care professionals are urged to monitor patients treated with Byetta for signs or symptoms of kidney problems. More information is available from the FDA.

Cordis and FDA recently notified health care professionals of a nationwide recall of all lots of the company’s CROSSOVER Sheath Introducer because of stretching or fracture of the sheath during use. In the event of a device fracture, separated segments of the device can embolize downstream in the bloodstream and impede blood flow, resulting in ischemia or infarct to the distal extremity. Unplanned open surgery may be required to remove the retained segments or control bleeding. View the MedWatch safety summary.