CMS approves electrophysiology physician specialty code

173

The Heart Rhythm Society has received notification that the society’s request for a physician specialty code for cardiac electrophysiology has been approved by the US Centers for Medicaid and Medicare Services (CMS).

Cardiac electrophysiology is the fastest growing of all the cardiovascular disciplines. Electrophysiologists are cardiologists who have additional education and training in the diagnosis and treatment of abnormal heart rhythms. Until now, there has been no mechanism for CMS to accurately distinguish cardiac electrophysiologists from other cardiologists in the Medicare claims database. The new physician specialty code designation will allow CMS to collect data on the work and practice expenses of electrophysiologists to more accurately measure use of physician resources and track patient treatment across episodes of care.

“The new physician specialty code is a major achievement for the Heart Rhythm Society and the field of electrophysiology,” said Douglas L Packer, president of the Heart Rhythm Society. “The new code will allow for the reporting of the involvement of two specialty physicians providing distinct services to an individual patient and will enhance our efforts to improve the quality of care for people living with heart rhythm disorders.”

The new designation code goes into effect on 4 April 2011.

On 22 November 2010, CMS issued the Physician Specialty Codes for Cardiac Electrophysiology and Sports Medicine Document and designated physician specialty code number 21 for cardiac electrophysiology. The establishment of the specialty code will require changes to the CMS enrolment and claims processing systems.

This new physician specialty code will allow CMS to more accurately measure use of physician resources and track patient treatment across episodes of care. Currently, there is no mechanism for CMS to accurately report on this category of physicians. The new specialty code will provide a mechanism to distinguish an electrophysiologist from a cardiologist when billing for Medicare services. For example, in the past, some local Medicare carriers have denied claims, citing duplicate billing, when a cardiologist and an EP from the same group practice billed consultation new patient evaluation services. The electrophysiology specialty code will allow for the reporting of the involvement of two specialty physicians providing distinct services to an individual patient.