Kidney groups and the vascular access community responding to a potential 17% cut in Medicare fees for vessel mapping paid off in the final rule issued last month for the 2012 Medicare Fee Schedule.
 
The service code for mapping of vessels for hemodialysis access –– G-0365 –– was one of a number of G codes facing a payment change under the proposed 2012 fee schedule. Medicare revised its Medicare Economic Index (MEI), which impacted the practice expense portion of the relative value units that make up the G codes. The codes are used by providers to bill Medicare for services.
 
The Centers for Medicare and Medicaid Services said the revisions reflected more accurate payment rates for these services relative to other fee schedule services.
But the American Society of Diagnostic and Interventional Nephrology, along with the Renal Physicians Association, voiced concern about the reduction, saying vessel mapping played an important role in creating an arteriovenous (AV) fistulae, a cornerstone of the agency’s own Fistula First Breakthrough Initiative.
 
 “The impact of your proposed change is a more than a 20% reduction in the relative value for this code. Such a drastic reduction in reimbursement could seriously adversely impact the care of patients with advanced chronic kidney disease and end-stage renal disease, “ wrote Donald Schon, MD and Gerald Beathard, MD, of ASDIN’s Public Policy Committee, and ASDIN president Timothy Pflederer, MD, in a letter to CMS on the proposed rule. “Assessing the patient with kidney failure for potential options for native arteriovenous fistula access and identifying the option most likely to mature to functional use is a complex process.  Vessel mapping has been well demonstrated in the medical literature to be critical to this preoperative evaluation. Assessment of both the extremity veins and arteries is required in the code descriptor. This vessel mapping often requires the use of both ultrasound and contrast venography, especially in the patient with prior central venous catheters and PICC lines. This high risk group of patients with potentially stenotic and damaged central and peripheral veins currently comprise over 70% of patients who initiate dialysis – incident patients who begin dialysis with a catheter.  In our opinion, the equipment, time and materials involved to accomplish appropriate vessel mapping do not warrant a reduction in the current practice expense RVU.”
 
In the final rule, CMS reversed the proposed reduction in PE RVUs, and the G code is now slated to be increased by over 5%. “The RPA commends CMS for its flexibility in acknowledging a proposed RVU change that would not benefit the common good of the Medicare program and its beneficiaries, and the Agency’s foresight in promptly reversing the proposed change,” wrote Association president Ruben L. Velez, MD.