Reimbursement changes with new PCI codes in 2013.

The Centers for Medicare and Medicaid Services (CMS) will reduce payment for coronary stenting on January 1, 2013. That is the bad news. More on that later. Is there any good news? Yes. First, CMS could have cut payments for coronary stenting 10 or more years ago, but it did not. Second, coronary stenting has been reimbursed for the past 17 years at a rate that was set in 1994. To appreciate that, one has to remember that 1994 was the year the STRESS [1] and BENESTENT [2] studies compared elective stenting to balloon angioplasty, and a randomized trial published in Catheterization and Cardiovascular Interventions compared then the state-of-the-art Palmaz-Schatz and Gianturco-Roubin II stents [3]. Elective stenting was just starting; most stents were placed to bail out failed balloon angioplasty. 1994 was also the year that CMS determined how much it would pay physicians to perform coronary stenting. The expert panel that advised CMS on reimbursement estimated that the average stenting procedure required 120 min of physician time from first injection of lidocaine to last catheter withdrawn, diagnostic catheterization not included. The expert panel also estimated that coronary stenting required 45 min of preparation time before the procedure and 60 min of physician work after the procedure, for a total physician work time of 225 min per coronary stenting case. Interventionalists have been paid at a rate based on about 4 hr per procedure for the past 17 years.