title: Diagnostic carotid and cerebral angiography: a historical summary of the evolving changes in coding and reimbursement in a complex procedure family.
abstract: Carotid and cerebral angiography have been a mainstay of neurointerventional and neuroradiologic practice for years. Centers for Medicare and Medicaid Services (CMS) and Relative Value Scale Update Committee (RUC) initiatives have compelled the professional societies to bundle component codes under threat of unilateral CMS revision and revaluation. Code bundling usually results in a decrease in the professional Relative Value Unit (RVU) valuation, and thus the MD reimbursement. The year 2013 saw a dramatic revision to the Current Procedural Terminology (CPT) code set that defines carotid and cerebral procedures. This paper reviews the process that led to that code set being revised and estimates the impact on professional reimbursement. We show the current and previous carotid angiography CPT codes and use clinical examples to assess professional RVU valuation before and after code revision.
authors.affiliation: The William W. Backus Hospital, Norwich, Connecticut, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Donovan
authors.affiliation: Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Thabele M
authors.initials: TM
authors.lastname: Leslie-Mazwi
authors.affiliation: South Texas Radiology Group, Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Silva
authors.affiliation: Department of Neurological Surgery and Radiology, Cerebrovascular Center, Stony Brook University Medical Center, Stony Brook, New York, USA.
authors.forename: Henry H
authors.initials: HH
authors.lastname: Woo
authors.affiliation: Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA.
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Nicola
authors.affiliation: Mecklenburg Radiology Associates P.A., Charlotte, North Carolina, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Barr
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Bello
authors.affiliation: Department of Progressive Radiology, The George Washington University, Falls Church, Virginia, USA.
authors.forename: Raymond
authors.initials: R
authors.lastname: Tu
authors.affiliation: Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Hirsch
mesh_terms: D002339:Carotid Arteries / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000175:diagnosis*; D014487:Centers for Medicare and Medicaid Services, U.S.; D002533:Cerebral Angiography / Q000379:methods*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007883:Legislation, Medical / Q000639:trends*; D006278:Medicare; D012051:Reimbursement Mechanisms; D015895:Relative Value Scales; D014481:United States
keywords: Angiography