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National Trends in Coronary Artery Disease Imaging Associations With Health Care Outcomes and Costs

Background In 2016, the National Institute for Health and Care Excellence Clinical Guideline Number 95 (“Chest pain of recent onset”) (CG95 recommended coronary computed tomography angiography (CCTA) as the first-line for possible angina.

Objectives The purpose of this study was to determine the impact of temporal trends in imaging use of outcome for coronary artery disease (CAD) following the CG95 recommendations.

Results

There was a rise in CCTA, decrease in myocardial perfusion imaging, and a modest fall in invasive coronary angiography. There was an apparent trend between computed tomography angiography growth and invasive catheter angiography reduction across regions.

CCTA growth was associated with a reduction in cardiovascular mortality, and ischemic heart disease deaths with an apparent trend with reduced all-cause mortality.

Conclusions

Imaging investigations for CAD are increasing. Greater regional increases in CCTA were associated with fewer hospitalizations for myocardial infarction and a more rapid decline in CAD mortality. (J Am Coll Cardiol Img 2022;-:-–-) Crown Copyright © 2022 Published by Elsevier on behalf of the American College of Cardiology Foundation. All rights reserved.

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CCTA could make diagnostic invasive angiography a thing of the past

Invasive diagnostic coronary angiograms have been the backbone of coronary artery disease (CAD) assessment for decades. However, many cardiology experts are predicting the rapid growth of coronary CT angiography (CCTA) will very soon eliminate the need for catheterizing patients just for diagnostic purposes. Rather, invasive cardiac catheterization will be used just to perform percutaneous coronary intervention (PCI), but we will screen and make treatment decisions based on CCTA.

Thought leaders in cardiac CT have been discussing the potential of such a trend for years, and now CT hardware, software and artificial intelligence (AI) have all caught up enough that it truly seems possible. In fact, interventional cardiologists and cardiac surgeons have now joined cardiac imagers in support of CCTA.
New CCTA technology, especially AI-driven advances in automation thanks to fractional flow reserve (FFR-CT) and soft plaque analysis, has given noninvasive CT diagnostic capabilities far beyond those of invasive angiography.

In addition, CCTA can support rural hospitals that don’t have cath labs and decrease the number of patients that require transfer to tertiary centers through more precise diagnostics of NSTEMI. The combination of AI and CCTA could help in those areas.

Some CT scanners are now more affordable and versatile pieces of equipment for hospitals and physician practices to obtain and operate. The newer software and AI tools streamline the training and workflows, providing efficient tools for diagnosis of coronary artery and valvular conditions.

Does your practice have the best options for cost effective identification of coronary artery disease?

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3 Steps For Getting the Most from Your Cardiac CTA Program?

Start by reviewing: CCTA Reimbursement Updates for 2025 below and align your charges as seen in 1, 2, 3.

U.S. CMS doubles reimbursement for cardiovascular CT services

reimbursement for cardiovascular CT services
The U.S. Centers for Medicare and Medicaid Services (CMS) has released its final rule for 2025 reimbursement: Coronary CTA (CCTA) has been elevated to a new Ambulatory Payment Classification (APC) classification, doubling reimbursement for this procedure in the hospital setting (OPPS) and increasing payment in the physician office setting (PFS) effective January 1, 2025. [1],[2]
  1. This highly anticipated update doubles the CCTA payment rate from $175 to $357.13, aligning Medicare reimbursement more appropriately with the value CCTA provides in cardiac care. This is a win for U.S. providers as well as the entire cardiac imaging community, ultimately improving patient access to this essential diagnostic tool.
  2. What should hospitals do now that CMS has approved this change?
    Hospitals should use the cardiology revenue code (0480) for CCTA services, when appropriate.
  3. New Category I CPT code issued for AI-enabled coronary plaque analysis software
The American Medical Association (AMA) has issued a new Category I CPT code for artificial intelligence (AI) based platforms that quantify coronary plaque buildup in imaging results and identify signs of coronary artery disease (CAD).[3] The update, scheduled to take effect in January 2026, covers AI offerings from multiple companies, including HeartFlow, Cleerly and Elucid. These technologies work by evaluating coronary CT angiography images and then alerting clinicians of any findings that represent CAD and high-risk features for heart attacks.

Coding: Plaque Analysis will be billed with the 4 CPT Category III codes approved for automated plaque analysis, effective late November 2024

CPT Category III codes

Announcement comes days after CMS expanded Medicare coverage for these platforms.

October has been a historic month for AI-powered coronary plaque analysis. Just days ago, the finalized a new local coverage determination (LCD) that expanded Medicare coverage for these same technologies. Four of seven Medicare Administrative Contractors (MACs) agreed to the updated policy, which went into effect on Nov. 24.

Now that you see how to improve your revenue capture in 3 simple steps, can the rest of your CCTA program performance use a boost in revenue performance through improved efficiencies?

Pulse Imaging Consultants has more ways to improve your Cardiac CTA program, improving throughput, patient and provider satisfaction, and improving overall performance. Contact us if you would like to know more.

[1] https://scct.org/news/news.asp?id=685976

[2] https://www.federalregister.gov/documents/2024/11/27/2024-25521/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical

[3] https://www.ama-assn.org/system/files/sept-2024-summary-of-panel-actions.pdf

[4] https://scct.org/page/HOPPScy25?_zs=6VO6X&_zl=DemW4
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