Health Policy Memo > Coding Information
New MPI Codes for 2010
January 4, 2010
Changes to the MPI codes were proposed in response to criticisms from the Medicare Payment Advisory Committee (MedPAC) and CMS. These groups asserted that the current coding structure allowed for reporting of multiple services on the same date by the same physician, resulting in duplicative payments for resources. An evaluation of codes found that MPI with wall motion and ejection fraction (CPT codes 78465, 78478, and 78480) were billed greater than 95 percent of the time together by the same physician.
ASNC, along with the American College of Cardiology, American College of Radiology, and SNM, reviewed these codes and presented new, packaged codes for the CPT panel’s consideration. These codes, which are reflected in the final AMA document, describe the entirety of the service requested. Codes for myocardial perfusion imaging and wall motion and ejection fraction will now be captured by single, packaged codes. Providers should note that stress tests (CPT codes 93105-93108) are billed separately in 2010 because these services were not billed with the same high frequency by the same physician as the MPI codes.
Table 1: 2010 MPI AMA CPT Code Changes (PDF)
Hospital Reimbursement Information
In 2008, the hospital outpatient prospective payment system (HOPPS) packaged the add-on MPI codes with the major procedure payment. Therefore, no significant reductions are in effect for 2010. However, it is critically important for hospitals to account for the added work when performing wall motion and ejection fraction services. Specifically, when establishing charges for the new codes, providers should add the charges they typically billed (charged) for wall motion and ejection fraction to the new 2010 codes. Hospitals should not simply crosswalk the base codes payment rates (eg., 78465-Tc) to the new coded CPT 78452-Tc without considering the total new costs. The increased 2010 charges will ensure CMS captures the added costs for wall motion and ejection fraction in the new total packaged 2010 CPT codes. If hospital providers do not update their charge masters for 2010, hospital rates could be jeopardized when CMS develops rates for 2012. (CMS uses data from the previous two years to set rates.)
HOPPS Reimbursement Information
Physician and IDTF Reimbursement Information
In contrast, physicians in an office setting or independent diagnostic testing facility are facing severe reductions in payments due to several factors (eg., change in practice expense rates, proposed changes to equipment utilization rates, change in malpractice values), including the packaging of codes and perceived overlap in the resource costs for MPI plus wall motion and ejection fraction. ASNC wants providers to be aware of these potential changes and urges members to visit www.asnc.org/mpfs2010 for updates on the Medicare Physician Fee Schedule. See Table 1 for details about the new coding changes for MPI in 2010.
Medicare Physician Fee Schedule Reimbursement Information
Third-Party Payer Reimbursement Information
Often third-party payers adopt the RVUs as published (or with slight modifications) in the MPFS. For 2010, CMS proposes significant policy changes and assumptions that ASNC believes do not appropriately represent provider costs. ASNC strongly advises its members to negotiate rates with third-party private payers that are representative of costs and set appropriate payment rates. ASNC, along with the ACC, is proactively addressing this with top payers. However, if you are negotiating rates for 2010 now, we recommend not linking any long-term contracts with third-party payers directly to the CMS RVUs for these newly bundled codes. Several third-party providers have responded to ASNC's inquiry about reimbursement for SPECT MPI in 2010. Click here for additional information.
