Provider Types Affected
Physicians and other providers needing to register Medicare patients receiving the Implantable Cardioverter Defibrillator (ICD) as primary prevention of sudden cardiac death

Provider Action Needed
Impact to You
The Centers for Medicare & Medicaid Services (CMS) has entered into an agreement with the American College of Cardiology National Cardiac Data Registry (ACC-NCDR) and determined that its ICD Registry satisfies Medicare’s requirements for reporting data on primary prevention ICDs.

What You Need to Know
Because the ACC-NCDR is now available, CMS will stop accepting data on the ICD Abstraction Tool through the Quality Network Exchange (QNet) on April 30, 2006.

What You Need to Do
In order for providers to continue to satisfy the National Coverage Determination (NCD) requirements for primary prevention ICDs, they will need to transition out of QNet and begin using the ACC-NCDR. CMS recommends that hospitals contact ACC-NCDR by January 1, 2006, to ensure that enrollment is complete by April 2006.

Background
When CMS expanded coverage for ICDs in January 2005, one of the requirements was for data to be reported by the provider for beneficiaries receiving ICDs for the primary prevention of sudden cardiac arrest. The NCD discusses in detail the clinical characteristics for primary prevention and the data reporting requirement for those populations. The NCD is available at http://www.cms.hhs.gov/coverage/icd.asp on the CMS Web site.

CMS established the ICD Abstraction Tool through QNet ( http://qnetexchange.org/public ), a system used by hospitals to report quality data to Medicare, to make available a data reporting system for providers that meets the data reporting requirements outlined in the NCD. CMS intended for the ICD Abstraction Tool to be temporary until a more complete registry became available; the result is the ACC-NCDR.

Additional Information
Because the ACC-NCDR is now available, the ICD Abstraction Tool through QNet will stop accepting data on April 30, 2006. For providers to continue to satisfy the NCD requirements for primary prevention ICDs, they will need to transition out of QNet and begin using ACC-NCDR. CMS recommends that hospitals contact ACC-NCDR by January 1, 2006, to ensure that enrollment is complete by April 2006.

Hospitals will need to work with the ACC-NCDR directly regarding participation. Information is available on the Web at http://www.accncdr.com/webncdr/ICD or by telephone at 1-800-253-4636, ext. 451.

Although the ACC-NCDR only enrolls hospitals, all provider types are responsible for ensuring that data is reported to the registry. Physicians and hospitals will need to work closely to ensure that all data elements are available for abstraction and entry into the registry.

Use of the QR modifier for physician and hospital outpatient claims remains the same. The QR modifier should continue to be appended to claims for ICD insertion when data is reported on the procedure. Data reporting, and therefore the QR modifier, is required for claims of primary prevention ICDs.

Reporting data for primary prevention of ICD implants is a requirement of Medicare coverage. Without appropriately reported data, Medicare may be unable to approve claims and/or may be required to take action to recoup payments already made if data reporting discrepancies are discovered through post-payment claims analysis.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

For more information, visit the Medlearn Matters Web page at: http://www.cms.hhs.gov/medlearn/matters/.

Medlearn Matters Number: SE0578
Related Change Request (CR) #: N/A
Related CR Release Date: N/A
Effective Date: N/A
Implementation Date: N/A

Posted: 11/29/2005

CPT codes, descriptions, and other data only are copyright 2005 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.