The Sage Group

THE SAGE GROUP Announces Publication of Peripheral Artery Disease Coding and Reimbursement Featuring an Overview of the Upcoming ICD-10 Diagnosis and Procedure Codes

ATLANTA, February 27, 2012 (BUSINESS WIRE)—Based on fiscal 2012 Medicare reimbursement data, THE SAGE GROUP has published a new analysis of coding and reimbursement for Peripheral Artery Disease (PAD). PAD is also sometimes known as peripheral vascular disease (PVD) or peripheral arterial occlusive disease (PAOD).

“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 PAD revascularization respectively,” stated Mary L. Yost author of the report.

According to Ms. Yost, “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 PAD and comparing these with the old ICD-9 codes.”

“Successful entry into the PAD 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 continued.

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

“Currently, both ICD-9 diagnostic and procedure codes and CPT codes are required for reimbursement,” stated Ms. Yost. “Another complicating factor is that Medicare employs two different reimbursement systems, one for hospital inpatient and another for outpatient procedures. Inpatient hospital service reimbursement is based on severity of illness diagnosis related groups (MS-DRGs), while outpatient services are reimbursed based on Ambulatory Payment Classification (APC) groups,” she continued.

Additional report information can be found at:

THE SAGE GROUP, a research and consulting company, specializes in atherosclerotic disease in the lower limbs, specifically PAD (Peripheral Artery Disease), CLI (Critical Limb Ischemia) and ALI (Acute Limb Ischemia). The most recent research focuses on PAD and diabetic foot ulcers and on the macroeconomic costs of PAD.

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Mary Yost, 404-520-6652