Specialist group asks for practice expense changes
Specialist group asks for practice expense changes
A medical group representing gynecologists has filed a request for numerous changes in the work RVUs for global surgical packages contained in HCFA’s practice expense proposal.
According to a request filed by the Society of Gynecologic Oncologists (SGO), the group supports HCFA s decision to increase work RVUs for global surgical packages to reflect the RVU increases for the evaluation and management (E/M) services components of global surgical packages. However, the group contends there are instances where HCFA failed to increase the RVUs for services with 10-day and 90-day global periods that are performed to treat gynecologic cancers. Also, "there are other instances where the update in the global surgical package has created an anomaly within the CPT codes used for gynecologic services," says Carolyn Runowicz, MD, chair of SGO’s government relations committee.
CPT code 56308. Laparoscopy with vaginal hysterectomy with or without removal of tube(s), with or without removal of ovary(s) (laparoscopic assisted vaginal hysterectomy). The proposed 1998 physician work RVUs for CPT code 56308 are 14.19. This number is less than the proposed 1998 physician work RVUs, 14.21, for CPT code 56309. In the 1997 physician fee schedule the physician work RVUs are 13.87 for CPT code 56308 and 13.79 for CPT code 56309. The relationship of the 1997 fee schedule should be maintained in the 1998 fee schedule.
CPT code 56351. Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D&C. The proposed 1998 physician work RVUs for CPT code 56351 are 2.85 RVUs. However, the proposed 1998 physician work RVUs for CPT code 58120, D&C, which are included within the CPT code 56351 service, are 3.27. SGO recommends that HCFA increase the RVUs for CPT code 56351 to accurately reflect the 3.27 RVUs for the D&C plus the RVUs for the hysteroscopy.
CPT code 56405, Incision and drainage of vulva or perineal abscess. The proposed 1998 physician work RVUs for CPT code 56405 are 1.39. However, the physician work RVUs for CPT code 56420 are 1.44. CPT code 56405 and 56420 are equivalent in physician work.
CPT codes 56630-56640, Family of Vulvectomy codes. The proposed 1998 physician work RVUs for the family of vulvectomy codes do not include the global surgical package update for all the codes. Also, this global surgical package update further compounds the existing anomalies created during the five-year review of physician work. The lack of an update for CPT codes 56631, 56634, and 56637 may have occurred because HCFA lacked data regarding the number of E/M visits. CPEP data on the number of post-operative visits for these codes exists. The number of postoperative E/M visits is five, and the global package adjustment for the 1998 fee schedule should be based on this figure.
CPT code 57800, Dilation of cervical canal, instrumental. In the 1998 proposed fee schedule, the physician work RVUs are .77 for CPT code 57800. Yet, the physician work RVUs for CPT code 57505, an almost identical procedure that does not require anesthesia or operating time (while CPT code 57800 does), are 1.14. HCFA should adjust the RVUs accordingly. In the 1998 proposed fee schedule, the physician work RVUs are .71 for CPT code 58100. Yet, the physician work RVUs for CPT code 57505, an almost identical procedure, are 1.14. HCFA should adjust the RVUs accordingly.
CPT code 58152, Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type). In the 1998 proposed fee schedule, CPT code 58152, a total abdominal hysterectomy plus a colpo-urethrocystopexy, was given fewer physician work RVUs than CPT code 58150, a total abdominal hysterectomy. Thus, a physician performing the service defined by CPT code 58150 is actually penalized for adding the additional procedure. HCFA needs to increase the work RVUs for CPT code 58152 to reflect the additional work of the colpo-urethrocystopexy.
CPT code 58285, Vaginal Hysterectomy, radical (Schauta type operation). SGO recommends to HCFA that it review the proposed physician work values for the vaginal hysterectomy codes vs. the abdominal hysterectomy codes for anomalies.
CPT code 58950, Resection of ovarian malignancy with bilateral salpingo-oophorectomy and omentectomy. SGO is concerned that in determining the physician work RVUs for 1998 for this CPT code, HCFA has neglected the E/M component of this service. This code is undervalued in relation to other services of this magnitude and intensity.
CPT code 58960, Laparotomy, for staging or restaging of ovarian malignancy. SGO is concerned that in determining the physician work RVUs for 1998 for this CPT code, HCFA has neglected the E/M component of this service. SGO feels this code is undervalued in relation to other services of this magnitude and intensity.
Actual Charges. When Medicare is the primary payer and a private plan is secondary payer, HCFA proposes to define Actual Charge as the lowest amount a physician has agreed to accept under the private plan contract. SGO opposes this change.
"Many secondary insurance plans covering Medicare beneficiaries also cover a wide range of other participants. Therefore, a contract that applies to a Medicare beneficiary is likely to have been negotiated with non-Medicare patients in mind," argues Runowicz.
Because discounted payments negotiated for a non-Medicare population typically do not account for the higher costs of caring for elderly or disabled patients, the combination of lower payments and additional administrative burdens only creates a disincentive for physicians to care for Medicare beneficiaries, contends SGO.
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