The Sage Group publishes analysis of coding and reimbursement for peripheral artery disease in the USA


The Sage Group has published a new analysis of coding and reimbursement for peripheral artery disease, based on fiscal 2012 US Medicare reimbursement data.

“In addition to annual revisions in reimbursement rates, all these systems continue to evolve. Major changes occurred in 2008 and 2011 with revisions to inpatient reimbursement and CPT codes for peripheral artery disease revascularisation respectively,” said Mary L Yost author of the report.

From October 2013 Medicare will require providers to switch to the ICD-10 diagnosis and procedure code system for reimbursement. Yost commented: “The October 2013 switch to ICD-10 diagnosis and procedure codes will have a profound impact on the entire reporting system. Consequently, we felt that it was important to provide an analysis of the current system, as well as an overview of the new ICD-10 system identifying specific ICD-10 codes relevant to peripheral artery disease and comparing these with the old ICD-9 codes.”

The report is designed to guide new entrants into the peripheral artery disease diagnostic and device markets to understand reimbursement and coding. “Successful entry into the peripheral artery disease diagnostic or therapeutic market requires understanding of the general concepts and principles of the coding and reimbursement system as well as the specific codes employed for diagnosis and treatment of the disease and an understanding of the relationships between the different systems,” Yost commented.

“Since Medicare is the dominant payer in the US healthcare system, they are the key decision maker for coding and reimbursement. Most commercial health plans follow Medicare coding and billing guidelines,” explained Yost.

Additional report information can be found here.