2020 AANA Advocacy Updates:

What You Need to Know Now

By Eric C. Stiefel, M.D.
Chair, AANA Advocacy Committee

Members of the AANA Advocacy Committee continue to support AANA members’ interest in advocacy and reimbursement. We would like to highlight a few of the initiatives AANA representatives have been working on in 2020.

COVID-19 Impact Analysis and Business Update

AANA leadership was first to market when it came to providing members with accurate and timely updates on compliance and government programs; these programs are aimed at minimizing the negative impacts of the cover pandemic on physicians and small business owners. Over 300 members took advantage of webinars that contained education programming ranging from optimal management of elective surgery patients to the Paycheck Protection Program and COVID-19 stimulus payments.

Single Anatomic Location

Removal of "shoulder is a single anatomic location" from the National Council on Compensation Insurance (NCCI) introductory language

One big win came earlier this year when the statement, "the shoulder is a single anatomic location" was removed from the introductory language of the NCCI edits. This change marked the conclusion of work done which started in 2016 with the unbundling of shoulder code 29823. It was our belief that this language was the central argument supporting bundling of many of the secondary codes in the family of arthroscopic shoulder surgery. AANA leadership partnered with the AAOS Advisor's Circle to request revision/removal of this language from the 2019 NCCI edits. We were successful in removing this inaccurate language in the 2020 NCCI edits.

Battle Over Superior Capsular Reconstruction (SCR)

The AANA Advocacy Committee formed a task force of specialty societies that includes AANA, the American Shoulder and Elbow Surgeons (ASES), The American Orthopaedic Society for Sports Medicine (AOSSM) and the American Academy of Orthopaedic Surgeons (AAOS) to advocate our request for changing the American Medical Association (AMA)’s recommendation to report superior capsular reconstruction (SCR) as an unlisted surgical procedure (29999). Significant historical president supported alternative coding options and was presented to the AMA CPT® Advisor with a request to revise their 2017 recommendation to report this procedure using an unlisted code. At the level of CPT® Editorial Panel, we were forced to abandon efforts to achieve this revised recommendation due to risk of resurvey (and revaluation) of the family of shoulder arthroscopy codes. Currently, AANA recognizes code 29999 as the appropriate code to use for isolated SCR procedures; however, we would note that in cases where a humeral-based repair of native rotor cuff tissue (for example: subscapularis or infraspinatus tendons) is performed, code 29827 can be reported as a base code in addition to code 29999 for the SCR repair. We encourage members to seek precertification when reporting SCR as an unlisted surgical procedure, with reference to code 29806.

CMS Identifies Debridement Codes as Potentially Misvalued

AANA members (with ASES and AAOS) updated the clinical vignettes for shoulder debridement codes 29823 and 29822. This update was aimed at helping members to better identify and appropriately apply these codes. In 2019, Centers for Medicare/Medicaid Services (CMS) targeted these codes as potentially misvalued, which triggered resurvey and potential revaluation. As previously defined by our position statement, AANA recognizes these two codes as unique procedures, representing precisely measured and defined physician input and work. AANA does not support arbitrary bundling of surgical procedures by Medicare or commercial payers.

Removal of Arbitrary Size Requirement From Loose Body Removal Codes

AANA Membership, with the help of stake-holding societies, participated in the revision of the clinical vignette for removal of loose body of the knee. While these changes will not take effect until 2021, the AAOS Global Service Data (GSD) will reflect revision in the “5 mm rule” to provide consistency across joints and avoid arbitrary assignment of physician work based on the size of a loose body. The new verbiage will recognize removal of loose body which cannot be removed by passive flow through the canal due to size, or removal through secondary incision.

New Code Request for Arthroscopic Labral Reconstruction of Hip

In response to member inquiries and CPT® advisory opinions recommending an “unlisted” procedural code, the AANA Advocacy Committee is working on a new code for arthroscopic labral reconstruction of the hip. The first step will be a submission or a draft code application to the AAOS Coding Coverage & Reimbursement (CCR) Committee in August 2020, where we will debate the risk/benefits of a new code for this surgical procedure.

AANA and General Advocacy

AANA continues to work with the AAOS Advisor's Circle and supports the following general advocacy agenda items:

  • Removal of surprise billing legislation, which would be detrimental to a member’s ability to negotiate contracts with commercial insurance companies
  • Support removal of moratorium on physician ownership of hospitals
  • Recommend that CMS reverse position of the 2019 proposed rule and provide a budget-neutral update to Evaluation & Management (E&M) payment to include global reimbursement for surgical procedures (global visits are office visits too!)

Your membership provides us with the opportunity and honor to continue working on the above and other important issues. We look forward to keeping you up-to-date on the progress our dedicated AANA advocacy members are making!

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