SGO Issues Feb 21, 2019
Combating compassion fatigue | Kimberly E. Resnick, MD
SGO Board Election winners announced, run-off for Fellow-in-Training member
Jolyn Taylor, MD, named first recipient of Coding Taskforce fellowship
Coding Corner: Brachytherapy Coding | James J. Burke, II, MD
Feb. 22 deadline for SGO Annual Meeting early bird housing rates
Request for applications open for GOG Foundation investigator awards
“We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our (patients)…Eventually, we lose a certain spark of optimism, humor and hope…We aren’t sick, but we aren’t ourselves.”
-C. Figley, 1995
That beseeching, fearful look. I know this look. These five faces that want answers, any answers—to the complicated scenario I just painted. I glance at my Apple watch. It’s 3:00. Shocked by what we found. Assumed that Ms. X had early stage endometrial cancer. Had to open due to findings. Stage 4 disease. It’s 3:05.
My stomach growls. I continue my litany. Couldn’t have predicted this. No way of knowing. No other symptoms. We took out the cancer in its entirety. It’s 3:07. It’s Valentine’s Day. I was in charge of the cupcakes for the Second Grade class party. I wonder if the boys liked them, wonder if they were too “girlie.” It’s 3:10.
Carcinomatosis, yes, like grains of sand. More treatment, chemotherapy. At my preoperative counseling I always state that we cannot know the exact stage until we operate, does anyone LISTEN to what I say? It’s 3:12. No, not in the liver or kidneys or rectum. Yes, I suppose that is good. But truly the horse is out of the barn. It’s 3:14.
I’ve started intermittent fasting as an attempt at self-care and self-preservation. I haven’t eaten in many hours. I’m reviewing the contents of the refrigerator. Thinking about how to make a low glycemic index dinner. It’s 3:16. More therapy will be needed. Yes. Chemotherapy. She is asleep. She doesn’t know this yet. She doesn’t know this yet.
I’m not burned out. I love what I do. Every day. But it’s lurking. At the door. Compassion fatigue. Mother Teresa knew it well. She mandated that her nuns take a 1 year sabbatical every 4-5 years in order to recover. To heal. In the stress literature compassion fatigue is known to have a more rapid onset than burnout. Burnout emerges over years…decades. Compassion fatigue can occur daily when our emotional bank account is literally empty. Working at the county hospital drains my account daily until…I just…can’t. The poverty, the chronic illness, psychiatric illness, domestic violence, drug use, lack of resources, lack of support staff—and the cancer—how can I not mention the CANCER? The stories wash over me like so many ripples in the ocean until I cannot separate them. The sadness abounds.
This is our call to action. Mine and yours. In every snide comment, every mumble to our nurse about a BMI—we are letting the compassion fatigue get the best of us. Dike Drummond, MD, notes that it is at this point that we need “exquisite self-care.” He suggests:
- Cutting hours to a minimum
- Only charting what is necessary-step away from the EMR
- Take a vacation (or a staycation)
- Get rest, get exercise
- Spend time with YOUR loved ones
In Judaism “tikkun olam” refers to healing the world. As doctors this is NOT our task. We are merely asked to heal one person at a time. The world can wait. Engage in the moment.
- Quote by C. Figley-Compassion Fatigue and Psychological Distress Among Social Workers: A Validation Study. Adams, R et al.
- Dike Drummond, MD – The Happy MD Blog
Kimberly E. Resnick, MD, is an Assistant Professor at MetroHealth Medical Center in Cleveland, OH.
The Society of Gynecologic Oncology congratulates the winners of the SGO open board election. S. Diane Yamada, MD, from the University of Chicago, was voted President-Elect II, and will begin her one-year term as SGO President after the 2021 SGO Annual Meeting in Seattle, WA. The open position for Fellow-in-Training Representative has ended in a tie, and a run-off election will be held between the three candidates to determine a winner. The election will open Tuesday, March 5, and will close Thursday, April 4. The following three candidates are on the ballot: Adrianne Mallen, MD, Moffitt Cancer Center/University of South Florida, Tampa, FL; Christina Rojas, MD, Walter Reed National Military Medical Center Bethesda, Vienna, VA; and Janelle Sobecki-Rausch, MD, MA, University of Wisconsin – Madison, Stoughton, WI.
The new members of the SGO Board of Directors will begin their terms after the Annual Meeting on Women’s Cancer, March 16-19, 2019, in Honolulu, HI. The final elected Fellow-in-Training Member will begin their term immediately upon the conclusion of the election and final approval from the Nominating Committee and SGO Board of Directors.
The SGO Coding Taskforce has selected Jolyn Taylor, MD, Assistant Professor at The University of Texas MD Anderson Cancer Center in Houston, TX, as the recipient of SGO’s first Coding Fellowship. The goal of the two-year fellowship program is to nurture and educate physicians on coding and health economics issues, providing the fellow with the tools necessary to advocate on the national level, develop educational tools for SGO membership, and take a leadership role in this vital area in the future.
As part of the coding fellowship, Dr. Taylor will attend the American College of Obstetricians and Gynecologists (ACOG) Committee on Health Economics and Coding (CHEC) meeting at ACOG Headquarters in July and December and the Current Procedural Terminology (CPT) editorial and American Medical Association RVS Update Committee (RUC) meetings as needed. Attending the SGO Coding Course at the SGO Annual Meeting and any SGO Coding Webinars is also an expectation of the fellowship.
Dr. Taylor said that she looks forward to learning more about the current coding system and how changes to it are proposed and passed.
“How the patient care we provide is coded has a significant impact on how our specialty is evaluated on a national level, including how we are compensated for our unique clinical expertise,” she said. “I believe it is important that we are able to advocate for ourselves through understand how coding affects our field.”
Dr. Taylor has a Master of Public Health degree that was focused on healthcare management and policy, and has completed courses related to the planning, management, and evaluation of health service systems, services, technologies, and policy including health economics, health services research, outcomes research and analysis of quantitative methodologies.
“As the Deputy Quality Officer in our department, my responsibilities include regularly reviewing the clinical documentation, especially related to procedures, complications or mortalities, and understanding how this documentation is interpreted by medical coders and is ultimately used to calculate quality of care metrics,” she said. “I’ve come to appreciate how complex and important coding is in relation to how our outcomes are evaluated and reimbursed. This fellowship is a unique opportunity to work with experts in our field and to develop an in-depth understanding of how documentation and coding affects our lives as physicians.”
There are instances when gynecologic oncologists are called to assist with brachytherapy as part of the treatment of patients with cervical, vaginal or recurrent endometrial carcinomas. However, medical coding for the work of these procedures is not straightforward as specific Current Procedural Terminology (CPT) codes do not exist. Below are vignettes where a gynecologic oncologist may assist with brachytherapy procedures and how those procedures might be coded.
Case number 1: The patient is a 47-year-old female with stage IIIB, grade 3 squamous cell carcinoma of the cervix who is undergoing radiation with concurrent chemotherapy. She is now ready for her brachytherapy and the radiation oncologist has asked for you to place a Smit sleeve (HDR stent) to aid in placement of tandem and ovoids for her brachytherapy. There are several ways to code for the work of these procedures:
- The gynecologic oncologist and the radiation oncologist perform the procedure together. The gynecologic oncologist performs a cervical dilatation and secures the Smit sleeve (HDR stent) with sutures while the radiation oncologist places the tandem and ovoids for the brachytherapy radiation. The most appropriate code coding for the procedure would be for the gynecologic oncologist and the radiation oncologist both to bill 57155 (Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy) and use a -62 modifier because two physicians are working together. The gynecologic oncologist cannot bill for the cervical dilatation (57800) as it is considered part of the 57155 code.
- The radiation oncologist asks the gynecologic oncologist to place a Smit sleeve for brachytherapy. The most appropriate way to code this procedure is to use the 57155 code with a -52 modifier to reflect reduced work for the procedure (the gynecologic oncologist is not placing the tandem and ovoid). You cannot bill for the cervical dilatation (57800) for the same reason as mentioned above. If the gynecologic oncologist places the tandem and ovoid, the appropriate code would be 57155 without a modifier as the entire procedure would be carried out by one physician.
Case number 2: A 65-year-old female patient with stage IB, grade 1 endometrioid carcinoma of the endometrium is found to have recurrent disease with a solitary nodule at the vaginal cuff. The patient has had no prior radiotherapy. The gynecologic oncologist takes the patient to the operating room where the lesion is excised from the vaginal apex and fiducial markers are placed in the periphery of the resection for radiation planning. The excision would be coded as a simple partial vaginectomy, 57106, and 49411 for placement of fiducial markers into the vaginal tissue at the vaginal apex.
Case number 3: The patient is an 81-year-old female patient with a stage IB, grade 3 endometrioid carcinoma of the endometrium was recommended to have vaginal brachytherapy for adjuvant treatment. The gynecologic oncologist placed the vaginal cylinder for her vaginal brachytherapy treatment. The most appropriate code for this work is 57156.
Case number 4: The patient is a 58-year-old female with stage IIIB, grade 2 squamous cell carcinoma of the vagina. The patient has completed her external beam radiotherapy with concurrent chemotherapy and is now ready for her brachytherapy. The gynecologic oncologist has been asked to assist in placement of the interstitial needles for brachytherapy. The radiation oncologist places the interstitial needles, transperineal. The gynecologic oncologist performs a laparoscopic procedure to help guide placement of the needles. The radiation oncologist would code 55920 for placement of the interstitial device and the gynecologic oncologist would code 49320 for a diagnostic laparoscopy.
James J. Burke, II, MD, is an Associate Professor and Director of Gynecologic Oncology at Mercer University School of Medicine in Macon, GA.
Tomorrow, Feb. 22, is the deadline for the special reduced housing rates for SGO Annual Meeting attendees. The official host hotel is the Hilton Hawaiian Village Waikiki Beach Resort; the Prince Waikiki Resort has already been sold out. Contact firstname.lastname@example.org with any questions.
The request for applications is now open for two new investigator awards through the GOG Foundation, in collaboration with NRG Oncology and the Society for Gynecologic Oncology. The submission period will open through March 29. The descriptions for these awards and links to the applications are as follows:
GOG Foundation Scholar Investigator Award: The purpose of this five-year award is to identify, enhance, and support training for Scholar Investigators who will be capable and committed to developing, executing, and leading gynecologic oncology clinical trials, conducting high-quality research related to gynecologic cancer, and participating in GOG Foundation/NRG Oncology and other relevant committee/leadership positions.
GOG Foundation New Investigator Award: The purpose of this three-year award is to identify New Investigators with an interest in clinical trials in gynecologic cancers who wish to become more engaged with the GOG Foundation and NRG Oncology and to learn more about the gynecologic cancer clinical trial development process. It is anticipated that New Investigators may pursue a GOG Foundation Scholar Investigator Award at the time of future requests for applications of that award.