![]() ![]() The Vizient Health Systems database, a large US hospital database, was used to compare acute complications in AF ablation with the contact force sensing THERMOCOOL SMARTTOUCH® Catheter or the THERMOCOOL SMARTTOUCH® SF Catheter (ST) versus the second-generation Arctic Front Advance™ Cryoablation Catheter (CB2) between September 2015 and June 2017. The objective of this study was to compare real-world safety outcomes with the latest catheter technologies used for the treatment of atrial fibrillation (AF). The revised code descriptors are shown below, with bolded phrases showing the newly bundled work.Real-world data can help medical administrators, physicians, and payers make evidence-based decisions regarding treatment choices. Additionally, 3D mapping systems that function in concert with new catheter technology now provide real-time assessment of the quality of the radiofrequency ablation lesion formation, allowing shorter duration of each radiofrequency application while also improving the quality of the lesions delivered. ![]() Catheter technology has also advanced, providing real-time assessment of the quality of contact between the catheter tip and the endocardial tissue. Shorter procedure times are likely due to a variety of factors, including improved systems that offer more detailed and accurate anatomical and electrical activation mapping, often completely eliminating the need for fluoroscopy. The 2021 surveys also showed significant reductions in procedure times. The ACC and HRS launched additional surveys in winter 2021 to confirm the accuracy of the 2020 surveys. The reductions in time were significant for the bundled codes. Physician work surveys executed by the ACC and HRS in the fall 2020 for the RUC demonstrated notable reductions in procedure times. Time is a key factor in fee-for-service RVU rate setting. Starting in 2022, these components will not be separately reportable. ![]() These revisions would also translate to the add-on codes for additional ablations. However, with new technology and clinical practices, these services are now nearly universally performed with SVT and/or AFib ablations.Īs such, while the CPT code numbers remain the same for these services, two of the five codes underwent significant revisions of code descriptors to incorporate (bundle) related services. When the current codes and descriptors were written in 2011, 3D mapping, left-atrial pacing and ICE were not typically performed with the underlying ablations. While the growth in services is appropriate and reflects evolving patterns of care in the past decade, it also reflects changes in performance of the services themselves. Through its ongoing review of potentially misvalued services, the AMA RUC in 2019 flagged EP ablation services for scrutiny because of significant growth in volume. RUC Recommendations From Resurvey Service In 2023, some values could go up slightly and others down slightly from what CMS finalized for 2022 if data from the second survey and recommendations are adopted. Information from the resurvey generally aligned with the first survey in showing large reductions in time. The agency also indicated additional changes could be made for 2023 based on information from the resurvey, which was not incorporated into 2022 rates. While additional survey information was available from a resurvey for the April 2021 American Medical Association RVU Update Committee (RUC) meeting to check the accuracy of the January 2021 surveys, CMS finalized its proposal to maintain the current work RVUs of SVT code 93653 and AF code 93656, while discounting the work of the bundled components for 2022. However, the final rule made no changes to the original proposal. The ACC also submitted formal written comments explaining information from a second work RVU survey and recommending a phase-in of reductions. The ACC and Heart Rhythm Society (HRS) staff and member leaders met multiple times with various agency officials and members of Congress to share information, questions and concerns on the physician fee schedule to ensure work RVU recommendations were clearly understood and informed by the best available information. These reductions essentially eliminate separate payment for 3D mapping, left-atrial pacing, and intracardiac echocardiography (ICE) when performed with supraventricular tachycardia (SVT) ablation and atrial fibrillation (AFib) ablation, as shown in the table below. As part of the 2022 Medicare Physician Fee Schedule final rule, the Centers for Medicare and Medicaid Services (CMS) implemented reductions to work relative value units (RVUs) for electrophysiology (EP) ablation services without any modifications. ![]()
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