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AUA Coding and
Reimbursement Committee
May 2010 Report
Respectfully
submitted by David H. Kauder, MD., FACS
This is my report as
the New England Section representative to the AUA’s Coding and Reimbursement
Committee (CRC) meeting that was held during the annual meeting in San
Francisco. Some of the committee’s
business is proprietary and not up for publication at this time. The charge of the committee is to review
requests from membership or industry for new procedures and technologies to see if they deserve a CPT
code. Once the proposals have met
the criteria established by the American Medical Association, the AUA will
support the creation of a new Category I CPT code or if criteria are not met, a Category III CPT code. Category III Tracking codes are essentially data collection codes. Category III CPT codes are carrier
priced. The American Medical Association has established
criteria and the CRC has aligned their review process with AMA CPT Panel
criteria. If a procedure or
technology passes a rigorous process, it may be granted a Category I CPT code. The Category I CPT code
is necessary for any procedure or new technology to receive reimbursement from
insurers. After the CPT code has
been approved, it then it passed through the rigorous AMA Relative Value Update
Committee (RUC) process. During
the RUC process, a CPT code is
assigned the RVU or relative value units for the physician work involved in the
service/procedure, practice expense and professional liability that help determine
YOUR FEES. The RVUs are then sent
to the Centers for Medicare and Medicaid Services (CMS) for final approval and
publication in the Federal Register in November 2010. The AMA CPT Panel and RUC meets three
times per year and if new codes or re-review, surveys will be sent out for
completion by our members.
Every five years the
AMA “asks” us to survey our members on codes considered mis-valued by CMS. The fourth Five Year Review occurs in2010 and thirteen common
urologic procedures listed below. There were an additional 9 codes surveyed in
2008 where some questions on the site of service were questioned and the AUA
was asked to comment on the codes to determine if they were valued
correctly. All codes during this
survey cycle will be reviewed at the October 2010 RUC meeting. The results of the survey may have significant effects on the RVUs and
thereby the fees you receive.
Codes requested
by CMS to be surveyed by AUA for Fourth Five-year Review |
51705 |
Change of cystostomy tube;
simple |
51710 |
Change of cystostomy tube;
complicated |
52005 |
Cystourethroscopy, with
ureteral catheterization, with or without irrigation, instillation, or
ureteropyelography, exclusive of radiologic service; |
52007 |
Cystourethroscopy, with
ureteral catheterization, with or without irrigation, instillation, or
ureteropyelography, exclusive of radiologic service; with brush biopsy of
ureter and/or renal pelvis |
52310 |
Cystourethroscopy, with
removal of foreign body, calculus, or ureteral stent from urethra or bladder
(separate procedure); simple |
52315 |
Cystourethroscopy, with
removal of foreign body, calculus, or ureteral stent from urethra or bladder
(separate procedure); complicated |
52630 |
Transurethral resection;
residual or regrowth of obstructive prostate tissue including control of postoperative
bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral
calibration and/or dilation, and internal urethrotomy are included) |
52640 |
Transurethral resection; of
postoperative bladder neck contracture |
52649 |
Laser enucleation of the
prostate with morcellation, including control of postoperative bleeding,
complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration
and/or dilation, internal urethrotomy and transurethral resection of prostate
are included if performed) |
53440 |
Sling operation for
correction of male urinary incontinence (eg, fascia or synthetic) |
53442 |
Removal or revision of sling
for male urinary incontinence (eg fascia or synthetic) |
57287 |
Removal or revision of
sling for stress incontinence (eg, fascia or synthetic) |
57288 |
Sling operation for stress
incontinence (eg, fascia or synthetic) |
How does the AUA get
survey information? Exactly as it
sounds – The AUA will send out a survey request and a link to the online
survey. It is extremely
important that you help if you are asked to fill out a survey. The
AUA needs 30 responses to validate a survey. To get to this they send out 1,400 emails and it is a
struggle to get to the 30. The surveys are the key to the data needed for
the RUC to determine your fees. Stephanie Stinchcomb from the AUA spoke to the MAPU
annual meeting regarding surveys last year.
It is important that
the survey respondents answer all questions as accurately as possible. Consideration should be given to the
time pre-operative time, intra-service time and post-operative times. If you get a request from the AUA, PLEASE ANSWER AND
HELP OUT.
Diagnosis coding for cancer versus history of
cancer
If you are treating a patient for a malignancy, you
should be using the usual ICD-9 diagnosis code for that malignancy. However, if the cancer is no longer
present and you are following the patient, using the V-code diagnosis which is
personal history of cancer X is appropriate. This would be true even for the patient that is undergoing a
surveillance cystoscopy and no tumor is found. The diagnosis should be the V-code for personal history of
bladder cancer. Using a v-code
should have no effect on the reimbursement by any payors. The official guidelines for ICD-9-CM
are listed below:
ICD-9-CM
Official Guidelines for Coding
and Reporting Effective October 1, 2009
Primary
malignancy previously excised
When a primary malignancy has been previously excised or
eradicated from its site and there is no further treatment directed to that
site and there is no evidence of any existing primary malignancy, a code from
category V10, Personal history of malignant neoplasm, should be used to
indicate the former site of the malignancy. Any mention of extension, invasion,
or metastasis to another site is coded as a secondary malignant neoplasm to
that site. The secondary site may be the principal or first-listed with the V10
code used as a secondary code.Admissions/Encounters
involving chemotherapy, immunotherapy and radiation therapy or Episode of care
involves surgical removal of neoplasm
When an episode of care involves the surgical removal of a
neoplasm, primary or secondary site, followed by adjunct chemotherapy or
radiation treatment during the same episode of care, the neoplasm code should
be assigned as principal or first-listed diagnosis, using the standard ICD-9 codes that have been
used not the “V-code” for history of cancer.
PQRI - Eligible professionals who successfully report in
2010-11 would receive a one percent bonus and 2012-14 would receive a 0.5
percent bonus. However, PQRI will
become mandatory in 2015 and those who fail to participate will face a 1.5
percent penalty, which will increase to 2 percent in 2016 and
thereafter
Legislative
Leadership Conference
On March 24th, 2004 several MAPU Board Members participated
in the Massachusetts Medical Society’s Legislative
Leadership Conference held at MMS Headquarters.
Drs. Jeffrey Steinberg, Susan Pursell and Jerry Rittenhouse
represented the state’s urologists in this interactive
workshop to improve advocacy efforts at the state and federal
levels.
Skills building sessions included challenging role-playing
scenarios on various topics including:
“ How to Testify: When You Have Two Minutes to Tell
Your Story and No One Seems to be Listening”
“ Black and White and Read All Over: Making Your
Case To the Media and the Public”
“ Making It Happen: Grassroots Strategies for Your District,Alliance
and Specialty Societies”
In addition, attendees met
with State Senator Robert Havern (D-Arlington) to get first
hand feedback on how to communicate
effectively with legislators.
In summary, your MAPU colleagues gained valuable skills to
further our important legislative agenda with our elected
officials – a
very worthwhile experience!
Printable
version of Newest Health Legislation
Here
is a list of legislative issues from the past several
years and a collection of position papers compiled by
the American Urological Association.
http://www.auanet.org/govtaffairs/
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