Case examples 1–5 demonstrating the changes to coding, RVU balance, and reimbursement under the revised Relative Value Scale Update Committee (RUC) recommendations
| Example # | Case | 2013 CPT codes | 2013 RVU | 2013 Physician work RVUs | 2013 National physician work reimbursement* |
|---|---|---|---|---|---|
| 1 | RICA angiography for follow-up s/p aneurysm coiling ▸ Inject RICA, imaging of brain | 36224 (RICA) | 6.50 | 6.50 | $346.01 |
| 2 | 3-vessel diagnostic angiography for CTA-negative SAH ▸ Catheter and inject RCCA; see disease in RICA bifurcation ▸ Keep catheter in RCCA for cerebral angiography ▸ Catheter and inject LCCA; LCCA imaging ▸ No carotid disease; advance into LICA, cerebral angiography ▸ Put catheter in LVA; inject | 36224 (LICA) | 6.50 | 12.06 | $598.79 |
| 36226-51 (LVA) | 3.25 | ||||
| 36223-59-51 (RCCA) | 2.31 | ||||
| 3 | Diagnostic evaluation for unruptured brain AVM ▸ Catheter into RCCA Cervical angiography ▸ Catheter into RICA Cerebral angiography ▸ RECA selected, cervical and cerebral angiography ▸ LCCA catheterized; cerebral angiography ▸ LVA catheterized and injected | 36224 (RICA) | 6.50 | 14.15 | $708.34 |
| 36226-51 (LVA) | 3.25 | ||||
| 36223-59-51 (LCCA) | 2.31 | ||||
| 36227 (RECA) | 2.09 | ||||
| 4 | Follow-up s/p coil embolization of RICA aneurysm ▸ Inject RCCA; images taken of the cervical carotid and brain ▸ Inject RVA; images taken of the vertebral artery ▸ Inject LCCA; images taken of the cervical carotid and brain ▸ Inject LVA; images taken of the vertebral artery | 36226 (RVA) | 6.50 | 14.25 | $758.36 |
| 36226-50 (LVA) | 3.25 | ||||
| 36223-51 (RCCA) | 3.00 | ||||
| 36223-50 (LCCA) | 1.50 | ||||
| 5 | Bilateral carotid angiography, superselective intracranial angiography, embolization of right frontal lobe AVM ▸ Inject LCCA; images taken of cervical carotid and brain ▸ Inject RCCA; roadmapping images taken of cervical and intracranial carotid ▸ Inject RICA; images of brain obtained ▸ Inject RACA; images of that vascular territory ▸ Inject two RACA branches ▸ Inject R ophthalmic artery ▸ Embolization of main trunk branch off RACA ▸ Post-embolization injection and imaging of brain | 36224-51 | 3.25 | 41.11 | $1953.03 |
| 36223-51-59 | 3.0 | ||||
| +36228 | 4.25 | ||||
| +36228 | 4.25 | ||||
| 75894/75898 | 1.32, 1.67 | ||||
| 61624 | 20.12 | ||||
RVU totals and reimbursement based on second quarter 2013 of the CMS Physician Fee Schedule. Fees are based on the Medicare Metropolitan Boston area carrier. Fees are subject to change and are paid based on the contract allowable.
CMS reduces modifier 51 by 1/2 on the first CPT and pays third CPT code and beyond at 25%. Modifiers 59 and 76 are paid at 100% of the contract allowable, depending on the reason for the modifier. Add-on CPT codes are also paid at 100% of the contract allowable.
*Not including Geographic Practice Cost Indices (GPCIs).AVM, arteriovenous malformation; CPT, current procedural terminology; CTA, CT angiogram; ICA, internal carotid artery; LCCA, left common carotid artery; LICA, left internal carotid artery; LVA, left vertebral artery; RACA, right anterior cerebral artery; RCCA, right common carotid artery; RICA, right internal carotid artery; RVA, right vertebral artery; RECA, right external carotid artery; RVU, Relative Value Unit; SAH, subarachnoid hemorrhage; s/p, status-post.