Drug Coding Advisor-HCFA policies on codes, pacemakers draw questions

Changes would be contained in 2001 fee schedule

The Health Care Financing Administration's (HCFA) proposal to create two new codes for physician supervision of patients' home health care is being called a potentially confusing situation by some provider organizations. HCFA is considering using the codes, which would only be used by Medicare, instead of using codes created by the American Medical Association's Current Procedure Terminology Editorial Panel.

"Every year or every other year, it seems like HCFA comes up with new codes as opposed to what CPT does," notes John DuMoulin, director of managed care and regulatory affairs for the American College of Physicians — American Society of Internal Medicine in Philadelphia.

"It's very frustrating because it's a real hindrance to people who are providing legitimate services that should be covered by Medicare."

HCFA to cut pacemaker payment by 60%

HCFA also wants to cut by Medicare payments to doctors who implant pacemakers and defibrillators by 60%. This drop in payment is the result of the agency's plan to split implantation surgery and postoperative reimbursement, which are currently bundled together, which would mean separate Medicare claims for the surgery and follow-up care.

HCFA says physicians will be able to compensate for any pay losses in the surgery component when they file claims for the follow-up care.

The problem is that HCFA assumes the physicians who implant those devices also provide the follow-up care, notes Robert Cannom, MD, president of the North American Society of Pacing and Electrophysiology.

"The majority of the time the physician who puts the pacemaker in never sees the patient again, particularly in a managed care environment," says Cannom. In turn, the proposal, "penalizes the implanting physician dramatically while benefiting the follow-up physician unrealistically."