AANA Code Requests to the Relative Value Update Committee (RUC)
*Open Knee Osteochondral Autograft Transplantation
1) Presented at the request of the AAOS to complete the previous cartilage codes; 2) AANA asked for the procedures to be equal but not supported by the surveys.
*Open Talar Osteochondral Autograft Transplantation
Four procedures in one 1) Malleolar osteotomy; 2) Arthroscopic or open harvest B knee; 3) Talar preparation and graft implantation; 4) ORIF of the malleolar osteotomy.
Coding Update
New ASC payment methodology
1) Discontinued the use of the nine Agrouper@ ASC payment system; 2) Replaced with the Ambulatory Payment Classification (APC) (41 and 42); 3) We have provided a complete Are-classification@ of all arthroscopic CPT codes using CMS claims/cost data; 4) CMS will reimburse the ASC 67% of the hospital outpatient department (HOPD); 5) Implant costs will not be reimbursed; 6) Advantageous for orthopaedic surgeons.
Ambulatory Payment Classification (APC)
1) AANA was successful at shifting several procedures from APC 41 to APC 42; 2) APC 41 = $1800; 3) APC 42 = $3000; 4) No Additional Implant Reimbursement; 5) Implemented over 5 years.
Physician Ownership: Under Fire
1) Physician ownership in health care is positive and should be encouraged; 2) Promotes cost effective care; 3) No increases in self referral patterns (Wood et al. JBJS, 87:1185-90,2005); 4) True motive/incentive alignment via cost reduction and appropriate utilization.
Coding Update
1) Support any and all politicians (Rep. Michael Burgess BTX) or lobbyist positions that preserve our right to be physician owners; 2) AAOS is creating a committee B the Health Systems Committee to evaluate, monitor and engage in non-physician reimbursement issues.
Coding Update
Assistants in Surgery List
Shoulder - 29806, 29807, 29827 (repair procedures)
Knee B 29879, 29882-83, 29885-87, 29888, 29889
Position Statement - AANA, AAOS?
The AAOS unequivocally believes that if a service or procedure has a Category I CPT code, it is not experimental or investigational. Therefore, payers should not deny coverage for these services and procedures by claiming that they are experimental or investigational.
Coding Update
1) CMS Practice Expense for Office Diagnostic Arthroscopy; 2) Part A vs. Part B Medicare; 3) No restriction on physicians providing this service; 4) Risk of diminution of existing RVU.
Site of Service Anomalies
1) Many surgical procedures have shifted from the hospital inpatient setting to the hospital outpatient surgery (HOPS) or ambulatory surgery center (ASC); 2) Physician work for surgical procedure includes post-operative care (90 day global); 3) Currently CMS/private payors are paying for in hospital post-op visits; 4) Must re-survey some codes (29888).
* See chart below.
| Requested/Current RVU |
Procedure |
RVU Received |
| |
|
|
| Arthroscopic Biceps Tenodesis |
|
|
| RVU's requested = 13.00 |
SLAP lesion repair, 29807 |
14.28 RVU's |
| Subtalar Arthroscopy |
|
|
| Removal of loose body = 8.50 RVU's |
Ankle removal loose body -29894 |
7.26 RVU's |
| Subtalar synovectomy=10.00 RVU's |
Ankle synovectomy - 29895 |
7.04 RVU's |
| Subtalar debridement=10.00 RVU's |
Ankle debridement - 29898 |
8.38 RVU's |
| Subtalar fusion=14.00 RVU's |
Arthroscopic ankle fusion - 29899 |
15.21 RVU's |
| Open Knee Osteochondral Autograft Transplantation |
|
|
| RVU's requested = 14.000 |
Arthroscopic osteochondral autograft transplantation -29866 |
14.48 RVU's |
| Open Talar Osteochondral Autograft Transplantation |
|
|
RVU's requested = 17.50
(75 percentils of survey respondents) |
Arthroscopic repair of OCD lesion, 29892 |
10.07 RVU's |
Health Policy Committee Update
The Health Policy Committee is actively involved in issues before the RUC ( RBRVS Update Committee) of the AMA with respect to coding issues that affect us as arthroscopists and general orthopedists. Last year, we presented 52 fracture codes for RUC re-evaluation. The AANA team was tasked with 11 shoulder and elbow fracture codes and we were very happy with the outcome of the RUC process which resulted in significant increases in RVUs for all the codes save one. The AMA then submitted the list to CMS for approval and we were disappointed to learn that the government had applied the rules regarding budget neutrality (BN) to the codes in any given body-part family. Anyone interested in reviewing their decision should refer to: http://www.cms.hhs.gov/physicianfeesched/downloads/CMS-1385-FC.pdf The pages to reference are 824 through 829. This resulted in significant decreases in the RVUs (see table below).
We are currently working to negotiate this with CMS on a number of different fronts, including the fact that their representative at the original RUC meeting did not have a problem with the increase in RVUs associated with the process. We also are restating the fact that our presentation met their standard of compelling evidence justifying RVU increases. I will document the outcome of our efforts in upcoming newsletters.
Bill Beach presented new codes for Biceps Tenodesis, Subtalar Arthroscopy, Open Osteochondral Allografting and Open Talar Osteochondral Allografting to the RUC. Please refer to his Coding Corner for a review of the valuations assigned for these procedures. Bill did a great job and we got some reasonable valuations. The RUC process can work in our favor if we get good data from the coding surveys!
Upcoming RUC issues will include a five year review of some arthroscopic codes that have not been reviewed and have valuation based on the older “Harvard” method. The main code we will be surveying will be 29888, arthroscopic ACL reconstruction. If you see a survey from the AAOS or AANA concerning this survey process, please read it and fill it out according to the instructions! It is important that we get good data concerning the amount of time it takes to really care for these patients to get proper RVUs assigned to the procedures. If anyone would like to fill out the form and has questions concerning the correct way to do it, please e-mail me at lfm@woapc.com.
