Federal Register, Volume 75, Number 226, November 24, 2010, Pages 71519-72652 Page: 71,842
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71842 Federal Register/Vol. 75, No. 226/Wednesday, November 24, 2010/Rules and Regulations
TABLE 6-NEW ENDOVASCULAR REVASCULARIZATION CPT PROCEDURE CODES EFFECTIVE JANUARY 1, 2011-
ContinuedCPT Code
Long descriptor
37226 .....................
37227 .....................
37228 .....................
37229 .....................
37230 ....................
37231 .....................
37232 .....................
37233 ....................
37234 ....................
37235 ....................Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent
placement(s), includes angioplasty within the same vessel, when performed.
Revascularization, endovascular, open or percutaneous, femoral/popliteal artery(s), unilateral; with transluminal stent
placement(s) and atherectomy, includes angioplasty within the same vessel, when performed.
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal
angioplasty.
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with atherectomy,
includes angioplasty within the same vessel, when performed.
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal
stent placement(s), includes angioplasty within the same vessel, when performed.
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, initial vessel; with transluminal
stent placement(s) and atherectomy, includes angioplasty within the same vessel, when performed.
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with
transluminal angioplasty (List separately in addition to code for primary procedure).
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with
atherectomy (List separately in addition to code for primary procedure), includes angioplasty within the same vessel,
when performed.
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with
transluminal stent placement(s) (List separately in addition to code for primary procedure), includes angioplasty within
the same vessel, when performed.
Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with
transluminal stent placement(s) and atherectomy (List separately in addition to code for primary procedure), includes
angioplasty within the same vessel, when performed.Our standard process for dealing with
new CPT codes is to assign the code to
the APC that we believe contains
services that are comparable with
respect to clinical characteristics and
resources required to furnish the
service. The new CPT code is given a
comment indicator of "NI" to identify it
as a new interim APC assignment for the
new year and the APC assignment for
the new codes is then open to public
comment. In some, but not all, cases, we
are able to use the existing data from
established codes to simulate an
estimated median cost for the new code
to guide us in the assignment of the new
code to an APC. In the case of the new
endovascular revascularization codes,
we were able to use the existing CY
2009 claims and most current cost
report data to create simulated median
costs for 12 of the 16 new separately
payable codes.
Specifically, to estimate the hospital
costs associated with the 16 new
endovascular revascularization CPT
codes based on their CY 2011
descriptors, we used claims data from
hospital outpatient claims submitted in
CY 2009 and the most recent cost report
information submitted by the hospitals
that submitted claims for the services as
they were reported in CY 2009. We note
that all of the services that were
previously reported to describe
endovascular revascularization of the
lower extremity for occlusive disease
were assigned to three APCs in CY 2009.
These included APCs 0082 (Coronary or
Non-Coronary Atherectomy), 0083(Coronary or Non-Coronary Angioplasty
and Percutaneous Valvuloplasty), and
0229 (Transcatheter Placement of
Intravascular Shunts).
Because the endovascular
revascularization CPT codes are new for
CY 2011, we used our CY 2009 single
and "pseudo" single claims data to
simulate the new CY 2011 CPT code
definitions. As shown in Table 7 below,
many of the new endovascular
revascularization CPT codes were
previously reported using a combination
of CY 2009 CPT codes. In order to
simulate median costs, we selected
claims that we believe meet the
definition for each of the new
endovascular revascularization CPT
codes. Table 7 shows the criteria we
applied to select a claim to be used in
the calculation of the median cost for
the new codes (shown in column A). We
developed these criteria based on our
clinicians' understanding of services
that were reported by CY 2009 CPT
codes that, in various combinations,
reflect the services provided that are
described by the new CPT codes for CY
2011. For example, in CY 2009, the
procedure described by new CY 2011
CPT code 37222 (Revascularization,
endovascular, open or percutaneous,
iliac artery, each additional ipsilateral
iliac vessel; with transluminal
angioplasty (List separately in addition
to code for primary procedure)) would
have been reported using the following
combination of procedures: (1) The
transluminal balloon angioplasty of the
iliac would have been reported usingCPT code 35454 (Transluminal balloon
angioplasty, open; iliac) or 35473
(Transluminal balloon angioplasty,
percutaneous; iliac); (2) the catheter
placement would have been reported
using CPT code 36248 (Selective
catheter placement, arterial system;
additional second order, third order,
and beyond, abdominal, pelvic, or lower
extremity artery branch, within a
vascular family (List in addition to code
for initial second or third order vessel
as appropriate)); and (3) the radiological
supervision and interpretation of the
transluminal balloon angioplasty would
have been reported using CPT code
75962 (Transluminal balloon
angioplasty, peripheral artery, other
than cervical carotid, renal or other
visceral artery, iliac or lower extremity,
radiological supervision and
interpretation) and/or 75964
(Transluminal balloon angioplasty, each
additional peripheral artery other than
cervical carotid, renal or other visceral
artery, iliac and lower extremity,
radiological supervision and
interpretation (List separately in
addition to code for primary
procedure)). In columns B, C, D, and E
of Table 7, for each new CY 2011 CPT
code listed under column A, we
identified the CY 2009 CPT codes that
we believed corresponded to each new
code for which we had CY 2009 claims
data and that we required or permitted
to be reported on the same line-item
date of service for a particular claim to
be used for calculating the median costs
for the new codes. Specifically, wei
i
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United States. Office of the Federal Register. Federal Register, Volume 75, Number 226, November 24, 2010, Pages 71519-72652, periodical, November 24, 2010; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc52807/m1/331/: accessed April 23, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.