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This alert is provided as a service to JR Associates’
clients and others who are interested in healthcare
reimbursement issues. For additional guidance about
this or related issues regarding coding, coverage
and payment, feel free to contact us directly at:
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An abdominal aortic aneurysm
(AAA) is an enlargement and weakening of the aorta
that can leak or rupture and cause life-threatening
bleeding. It is usually asymptomatic and is often
found incidentally during testing for other conditions.
When detected early, an AAA defect can be repaired
with surgery before it becomes a problem. Now, thanks
to the Screening Abdominal Aortic Aneurysm Very
Efficiently Act (SAAAVE) passed by Congress in 2006
and effective January, 1, 2007, new Medicare recipients
may be eligible for a screening abdominal ultrasound
to determine the presence of an AAA.
Coverage Criteria
The Centers for Medicare & Medicaid Services
(CMS) released final details of SAAAVE in the Medicare
Physician Fee Schedule rule in late 2006. AAA ultrasound
screening is covered only once by Medicare, and
the beneficiary must be referred by a physician
or qualified nonphysician provider (such as a clinical
nurse specialist, nurse practitioner or medical
assistant) during an Initial Preventive Physical
Examination (IPPE).
An IPPE is a one-time exam
available for new Part B beneficiaries. It must
be completed within the first six months of coverage.
During the exam, the practitioner is required to
provide education and counseling for covered preventive
services, including the AAA screening ultrasound.
The eligible beneficiary does
not need to show signs or symptoms of disease, but
must fit at least one of the following risk profiles:
Male or female with a family
history of an AAA; or
Male age 65 to 75 who has smoked at least 100 cigarettes
in his lifetime.
Coding/Payment
Medicare has initiated a new HCPCS code, G0389-Ultrasound
screening for AAA to report this exam. Payment has
been established at the same level as a limited
retroperitoneal ultrasound exam (CPT 76775).
2007 National Medicare
Approved Payments
Physician Fee Schedule: (Physician and IDTF)
(calculated with a conversion factor of $37.90)
Global $90
Professional $29
Technical $61
Hospital Outpatient Prospective
Payment System (Hospital Outpatients)
APC 0266 $96
Private Payers
Many health insurance plans also provide coverage
for a screening AAA ultrasound as part of a preventive
health guideline or benefit. The qualifying criteria
are often the same as Medicare. Check individual
plans regarding coverage, codes and payment.
Learn about coding solutions
available from JR Associates:
2007
Ultrasound Coding Reference Guide
2007
Cardiovascular Coding Reference Guide
