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The new code, DRG 559, will go into effect on October 1 and will set reimbursement for the treatment at $11,578. Prior to this, DRG codes for stroke limited reimbursement to $4,000 to $6,000, regardless of the type of therapy provided to patients. Treatment with a thrombolytic agent is more expensive than other stroke services because it involves increased costs for intensive care unit monitoring, diagnostic imaging, and for the services of laboratories and pharmacies.
Steven Rush, Practice and Patient Safety Manager at the AAN Center for Health Policy, said AAN representatives Walter J. Koroshetz, MD, Lawrence M. Brass, MD, and Joseph P. Broderick, MD, along with the American Stroke Association and the Brain Attack Coalition, had advocated for this change, bringing data to the CMS that supported evidence for increased costs related to this treatment.
Mr. Rush said better reimbursement rates allow hospitals to be compensated for the types of care being provided and will enhance the probability that patients will get the most appropriate treatment. He added that when hospitals see that they can be better reimbursed for providing stroke care, there is the potential for neurologists to contract with hospitals for in-call services.
