Jonathan,
Eyes doing better after eight hours of being closed.
I seem to have gotten one thing wrong in my previous post.
"I do know that the HCFA will reimburse the IVUS procedure, but I don't know where they are on stents themselves." Well, if I'm reading the following correctly, that's not quite right.
hcfa.gov
"IVUS and ELCA are not stand-alone diagnostic or therapeutic procedures. They must be bundled with other procedures, and therefore ineligible for additional payment. Arguments that IVUS and ELCA represent additional work and interpretation are not valid because the main procedure, cardiac catheterization, has become less labor intensive with experience and expertise. The amount of effort involved is little more than that associated with the main procedure and they lowers the risk associated with the procedure.
IVUS and ELCA are coverable procedures without additional payment allowed. Cardiac stents and the procedure to deploy them, are coverable at the discretion of the carrier. However, payment for the device would be included in the DRG rate."
If I am understanding this correctly, HCFA will not disallow coverage of a cardiac catheterization procedure if stents and IVUS are used, but will not pay for additional cost of either of them, though the patient's insurance company may do so if it feels so inclined. I do not know what the DRG rate is.
This is from '96, but again, I can't find anything more recent.
Still Digging, Tuck |
