Presidential Matters July 2015

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July 2015

Dear Colleagues,

Summer is here and many of us are enjoying well-earned rest and relaxation. As you enjoy time with friends and family, the Society of Gynecologic Oncology (SGO) and its volunteer leaders remain actively engaged in the effort to ensure you are appropriately reimbursed for laparoscopic hysterectomies.

As you know, the Relative Value Units (RVUs) for CPT codes 58570, 58571, 58572, and 58573 were reduced by as much as 12 to 22 percent effective Jan. 1, 2015. In my April Presidential Matters column, I outlined SGO’s strategies for addressing these RVU reductions. One was the development of new codes for laparoscopic staging and debulking of gynecologic cancers. Currently, the SGO Coding and Reimbursement Taskforce is carefully exploring this option. Given the weight and complexity of this task, I want all SGO members to stay focused and informed. It can take 12 to 18 months to develop and propose a new CPT code, and then more time to get it valued appropriately and approved. Fortunately, we have substantial expertise in this domain represented by our Coding and Reimbursement Taskforce leadership.

While several options are on the table, SGO is considering two new codes: 1) Laparoscopic pelvic and paraortic lymph node dissection with omentectomy for staging of gynecologic malignancy, covering ovarian cancer staging and uterine serous carcinoma staging. This could be added to the documented hysterectomy used; and 2) Laparoscopic resection of a gynecologic malignancy with omentectomy with or without retroperitoneal lymph node sampling, covering primary, interval, or secondary debulking of ovarian cancer. This could be added to the documented hysterectomy and bilateral salpingo-oophorectomy codes.

While these codes would appear intuitive, we have to recall that the Medicare budget for physician payments is a fixed amount of money; the unintended consequence of proposing new CPT codes is downward valuation on existing procedures that SGO members perform, particularly if the new codes are utilized in high volume. Therefore, the SGO must find the best way to work within this zero-sum game to the benefit of our members and your patients.

Most recently, SGO succeeded in gaining assignment of the laparoscopic hysterectomy codes to the Centers for Medicare and Medicaid Services’ (CMS) formal refinement process. This is one avenue that will allow for SGO to appeal the lower RVUs that have been assigned to these codes for 2015. Many thanks to all SGO members who participated in the survey about the number and level of post-operative visits performed that are part of the global period for these procedures. This data along, with additional data regarding minutes of intra-service work collected by the SGO Coding and Reimbursement Taskforce, will be used on Aug. 18, 2015, for this refinement panel exercise. Following that, SGO may still consider other activities to engage the CMS on this issue.

The SGO Board of Directors will be discussing these matters in more depth at its meeting next week. We would love to hear from you. Tell me what you think of the codes we are considering. What are we missing? Write me now at robert.coleman@sgo.org, then get back to your summer fun.

Best Regards,

Robert L. Coleman, MD

P.S. Speaking of coding, SGO will present webinars on July 22 and Sept 30 to help members transition to ICD-10 codes by the Oct. 1 deadline. Get more details and register here.