After approving a new specialty designation for "Adult Congenital Heart Disease" (ACHD) in March, the Centers for Medicare and Medicaid Services (CMS) has completed the necessary steps to create the code and make it available for physicians to use in their provider enrollment, effective Oct. 1.

Having this new designation allows CMS to distinguish ACHD physicians from clinical cardiologists when billing for Medicare services, and to correctly identify this category of physicians for quality and payment programs while acquiring robust data. Some local Medicare carriers have denied claims in the past, citing duplicate billing, when a cardiologist and an ACHD specialist from the same practice have billed for patient evaluation services.

Any provider who selects a specialty code is attesting that they meet federal and state requirements for the specialty and are "properly staffed, equipped and stocked (as applicable, based on the type of facility or organization, provider or supplier specialty, or the services or items being rendered) to furnish these items or services."

ACC encourages ACHD members to enroll or update their specialty to reflect the new specialty code "D8" within 60 days of the Oct. 1 implementation date. ACHD members are also encouraged to contact their administrators and billing staffs to enroll or update their specialty to reflect this new designation within 60 days of the implementation date. More information is available from CMS here and here.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Congenital Heart Disease

Keywords: ACC Advocacy, Centers for Medicare and Medicaid Services, U.S., Medicare, Medicaid, Heart Defects, Congenital

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