SGO Issues Aug 8, 2019

SGO Issues August 8, 2019

New SGO Conflict of Interest policy sets compensation limits on leaders, volunteers
SGO 2020 Practice Survey opens Aug 15
GOG Foundation Announces $3.5 million investment in 10 scholar investigators and 36 new investigators
Coding Corner: Cesarean hysterectomy | Mary J. Cunningham, MD
Vulvar cancer highlighted in August Gynecologic Oncology journal

New SGO Conflict of Interest policy sets compensation limits on leaders, volunteers

SGO has updated its Conflict of Interest (COI) policy to include compensation limits, from outside businesses or companies that may appear to influence an SGO meeting, program or the Society as a whole, for officers, board members and committee and task force members. The new policy also establishes a formal process for mitigating COI’s and Commitments and establishes an audit for reviewing and addressing any potential conflicts. The new compensation limits are as follows:

  • SGO President: $0
  • Society Executive Committee, Board of Directors and Program Committee Chairs: $25,000
  • Committee and Task Force members: $50,000

The COI policy was revised over the course of a year by the SGO Professional Ethics Committee, headed by Monique Spillman, MD, and Vivian von Gruenigen, MD, and was approved by the SGO Board of Directors in July. Dr. Spillman explained that the compensation limits are for commercial entities such as drug/device manufacturers, but do not apply to a physician’s surgical and clinical practice of medicine as a gynecologic oncologist.

The updates allow officers other than the President to hold positions in other professional societies or relevant organizations, and includes all committees and task forces.

“I think the important overall goal of the revision of the policy is to assure our members, patients and the public that the leadership of the SGO is working to present unbiased, comprehensive scientific data to push the field of gynecologic oncology forward,” explained Dr. Spillman. “We want to be transparent and to have assurances that our leaders are aware of any conflicts with their external roles. This is particularly important with the SGO President.”

Dr. Spillman noted that it is important for future SGO leaders to realize the standards to which they will be held. Under this updated COI policy, the newly elected President-Elect II will have at least two years to divest activities that would be in conflict with the policy. The SGO President will be unable to accept any outside compensation during their tenure.

The prohibition against outside compensation for the President is similar to prohibitions for members of National Academy of Medicine panels. The compensation limits for the Program Committee chairs also reflects similar prohibitions for National Cancer Institute clinical trials groups.

“In revising the policy, we noted that COI are not only financial–conflicts of commitment can occur as well when one of our talented leaders serves a similar role in another organization, whether a direct competitor organization, or an affiliated one,” said Dr. Spillman. “SGO leaders have a fiduciary duty to our organization first. If they have other roles in other organizations, those roles must be vetted for conflict of commitments. Also, other leadership roles may require an amount of time that could have deleterious effects on the work of SGO.”

SGO 2020 Practice Survey opens Aug 15

The SGO 2020 Practice Survey will open to full and advanced practice provider (APP) members on Aug. 15. An email link to the survey will be sent to eligible members and the survey will close on Sept. 12. Please add noreply@surveygizmo.com and invites@mailer.surveygizmo.com to your Safe Senders list. Data from this five-year benchmarking tool will provide insights into the ever-evolving practice of gynecologic oncology and how the subspecialty can best meet patient needs.

Eligible SGO members who complete the survey will receive a free electronic copy of the results—a value of $60–and be entered to win a free registration to the SGO 2020 Annual Meeting on Women’s Cancer, March 28-31 in Toronto, Canada. SGO Past President Barbara Goff, MD, and David M. Kushner, MD, co-chairs of the SGO 2020 Practice Survey Taskforce, explained that the survey is more streamlined than the 2015 survey, so it will be easier for members to answer most of the questions without needing to look up data.

“This will be the first time that we will be able to get a snap-shot of the practice patterns of the new, inclusive SGO membership,” said Dr. Kushner. “Given the busy schedule of most of our members, we pared the survey down to only the critical issues. Most providers should need a maximum of 30 minutes to complete, and do so without needing the help of their practice administrators.”

The new Practice Survey also includes questions about cutting-edge treatments of gynecologic cancer, wellness and burn out.

Dr. Goff noted that a large participation rate for the survey will give SGO accurate data on salary, benefits, support staff, call and time given for administration, research and teaching. “We get an accurate look at how our specialty is practicing medicine and what are the challenges that many of us face,” said Dr. Goff.

Dr. Goff added that the 2020 edition of the SGO Practice Survey will be very helpful for members to compare their practice to others and identify if they are being treated fairly in their current employment situation and how their treatment of gynecologic cancer may vary from their peers.

“This information is invaluable to members as they negotiate with employers, hire staff, set up service lines and think about work life balance,” she said. “It is also very helpful for SGO, as it helps us set priorities to focus resources.”

GOG Foundation Announces $3.5 million investment in 10 scholar investigators and 36 new investigators

On July 18 the GOG Foundation Education and Mentoring Committee awarded $3.5 million in research grants to 10 scholar investigators and 36 new investigators in gynecologic oncology during the NRG Oncology Semi-Annual Conference in Philadelphia. “This initiative demonstrates GOG Foundation’s commitment to develop the next generation of GOG Foundation and NRG Oncology leaders in gynecologic oncology,” said Larry J. Copeland, MD, President of the GOG Foundation.

“The programs also aim to enhance the knowledge of the broader GOG-Foundation/NRG Oncology community on current and evolving prevention and treatment strategies for gynecologic and other relevant cancers and on current and evolving clinical and translational research strategies,” said Committee Co-chair Ronald D. Alvarez, MD, MBA

Scholar Investigators
The 10 scholar investigators were selected from among 50 applicants. Scholars will be expected to develop and implement phase II/III trials in gynecologic oncology and advance to leadership positions within the GOG Foundation and NRG Oncology by the end of their award term. Each scholar investigator receives a five-year grant (continuation dependent upon progress as assessed by review of annual progress report), a $20,000 annual stipend for their mentor, a $1,500 stipend to support travel to semiannual NRG Oncology meetings, free registration to GOG-F Symposiums and the Society of Gynecologic Oncology (SGO) Clinical Trials Workshop, and up to $50,000 in support of meritorious proposals for clinical trial development.

  • Rebecca Arend, MD – Gynecologic Oncology, University of Alabama at Birmingham
  • Emma Barber, MD – Gynecologic Oncology, Northwestern University
  • Lisa Barroilhet, MD – Gynecologic Oncology, University of Wisconsin-Madison
  • Katherine Fuh, MD, PhD – Gynecologic Oncology, Washington University School of Medicine in St. Louis
  • Stephanie Gaillard, MD, PhD – Medical Oncology, Johns Hopkins Sidney Kimmel Cancer Center
  • Lilian Gien, MD – Gynecologic Oncology, Sunnybrook Research Institute
  • Debra Richardson, MD – Gynecologic Oncology, The University of Oklahoma Health Sciences Center
  • Ritu Salani, MD, MBA – Gynecologic Oncology, The Ohio State University
  • Shannon Westin, MD, MPH – Gynecologic Oncology, The University of Texas MD Anderson Cancer Center
  • Dmitriy Zamarin, MD, PhD – Medical Oncology, Memorial Sloan Kettering Cancer Center

New Investigators
The 36 new investigators were chosen from a pool of 75 applicants. New investigators will be expected to become more engaged with the GOG Foundation and NRG Oncology and to learn more about the gynecologic cancer clinical trial development process. Each new investigator receives a three-year grant, $1,500 stipend to support travel to semiannual NRG Oncology meetings, and free registration to GOG-F Symposiums and the SGO Clinical Trials Workshop.

  • Mariam Al Hilli, MD – Gynecologic Oncology, Cleveland Clinic
  • Jill Alldredge, MD – Gynecologic Oncology, University of Colorado
  • Joyce Barlin, MD – Gynecologic Oncology, Women’s Cancer Care Associates
  • Saveri Bhattacharya, DO –Medical Oncology, Thomas Jefferson University
  • Stephen Bush, MD – Gynecologic Oncology, West Virginia University
  • Yovanni Casablanca, MD – Gynecologic Oncology, Walter Reed National Military Medical Center
  • Lauren Cobb, MD – Gynecologic Oncology, The University of Texas MD Anderson Cancer Center
  • Joshua Cohen, MD – Gynecologic Oncology, University of California, Los Angeles
  • Bradley Corr, MD – Gynecologic Oncology, University of Colorado
  • Erin Crane, MD, MPH – Gynecologic Oncology, Levine Cancer Institute
  • Eric Donnelly, MD – Radiation Oncology, Northwestern University
  • Britt Erickson, MD – Gynecologic Oncology, University of Minnesota
  • Katharine Esselen, MD, MBA – Gynecologic Oncology – Beth Israel Deaconess
  • Erin George, MD – Gynecologic Oncology, University of Pennsylvania
  • Eugenia Girda, MD – Gynecologic Oncology, Rutgers Cancer Institute of New Jersey
  • Allison Gockley, MD – Gynecologic Oncology, Brigham and Women’s Hospital
  • Gregory Gressel, MD, MS – Gynecologic Oncology, Albert Einstein College of Medicine
  • Camille Gunderson, MD, MS –Gynecologic Oncology, University of Oklahoma Stephenson Cancer Center
  • Kathy Han, MD – Radiation Oncology, Princess Margaret Cancer Centre
  • Marilyn Huang, MD, MS – Gynecologic Oncology, University of Miami Sylvester Comprehensive Cancer Center
  • Katherine Kurnit, MD, MPH – Gynecologic Oncology, University of Chicago
  • Lindsay Kuroki, MD, MSCI – Gynecologic Oncology, Washington University School of Medicine in St. Louis
  • Ken Lin, MD, PhD – Gynecologic Oncology, Montefiore Medical Center
  • Gina Mantia-Smaldone, MD – Gynecologic Oncology, Fox Chase Cancer Center
  • Kathryn Mills, MD – Gynecologic Oncology, University of Chicago
  • Mary Mullen, MD – Gynecologic Oncology, Washington University School of Medicine in St. Louis
  • Kathryn Pennington, MD – Gynecologic Oncology – University of Washington
  • Rebecca Previs, MD, BS, MS– Gynecologic Oncology, Duke Health
  • Tyler Robin, MD, PhD, Radiation Oncology, University of Colorado
  • Jennifer Veneris, MD, PhD – Medical Oncology, Dana-Farber Cancer Institute
  • Danielle Vicus, MD, MSc, FRCSC – Gynecologic Oncology, Sunnybrook Health Sciences Center
  • Heather Williams, MD – Gynecologic Oncology, Medical College of Georgia
  • Lyndsay Willmott, MD – Gynecologic Oncology, Arizona Oncology
  • Boris Winterhoff, MD, MS – Gynecologic Oncology – University Minnesota
  • Juliet Wolford, MLARP, MS-BATS, MD – Gynecologic Oncology, University of California, Irvine
  • Emi Yoshida, MD – Radiation Oncology, University of California, San Francisco

Education and Mentoring Committee
This program is indebted to SGO and NRG Oncology for their partnership in this effort and thanks the following members of the Education and Mentoring Committee and others that assisted in the review of submitted proposals:

  • Ronald D. Alvarez, MD, MBA – Co-Chair
  • Angeles Alvarez Secord, MD, MHSc – Co-chair
  • Elise C. Kohn, MD – Head, NCI DCTD Gynecologic Cancer Therapeutics
  • Laurel W. Rice, MD – 2017-2018 SGO President
  • Warner K. Huh, MD – 2019-2020 SGO President
  • David G. Mutch, MD – Chair, Foundation for Women’s Cancer
  • Michelle Small – GOG-Foundation Administrative Support
  • Additional review assistance provided by Carol A. Aghajanian, MD, and Robert L. Coleman, MD

Coding Corner: Cesarean hysterectomy | Mary J. Cunningham, MD

Mary J. Cunningham, MD

It is not uncommon for a gynecologic oncologist to be consulted when a hysterectomy must be performed at the time of cesarean section. The way in which the surgery is coded depends on the details of who performed each part of the procedure. The code for subtotal or total hysterectomy after cesarean delivery is +59525– RVU(relative value unit) 12.80. The “+” indicates an add-on code that must be billed in combination with other specified codes. In this case +59525 needs to be billed in addition to the appropriate delivery code (59510, 59514, 59515, 59618, 59620, 59622).

In the description of every add-on code in CPT there is a parenthetical statement that lists the acceptable codes that must be used in conjunction with the add-on code. If the obstetrician performs both the cesarean section and the hysterectomy then these codes can be used.

If the OB/GYN performs the cesarean delivery and the gynecologic oncologist performs the hysterectomy, the Gyn Onc can bill 58150 for a total hysterectomy (RVU 27.31) or 58180 for a supracervical hysterectomy (RVU 25.83). The obstetrician will separately bill the delivery.

The diagnosis codes most commonly used for these procedures are found in the obstetrics section of ICD-10: O42.2 Morbidly adherent placenta (with subcategories for accreta, increta and percreta as well as trimester) and O72.0 postpartum hemorrhage with adherent placenta.

In conclusion, correct coding for a hysterectomy at the time of cesarean delivery requires considering the role that each surgeon played during the procedure.

Mary J. Cunningham, MD, is a gynecologic oncologist at GYN Oncology of Central New York, and Director of Gynecologic Oncology at SUNY Upstate Medical University in Syracuse, NY.

Vulvar cancer highlighted in August Gynecologic Oncology journal

Editorial: Margins in vulvar cancer: challenges to classical clinicopathologic vulvar recurrence risk factors Sara Dudley, Akila Viswanathan
Lead Article: Margin status revisited in vulvar squamous cell carcinoma N.C. te Grootenhuis, A.W. Pouwer, G.H. de Bock, H. Hollema, J. Bulten, A.G.J. van der Zee, J.A. de Hullu, M.H.M. Oonk
Vulvar Cancer: Role of adjuvant radiation or re-excision for early stage vulvar squamous cell carcinoma with positive or close surgical margins Sabrina M. Bedell, Chloe Hedberg, Anna Griffin, Hannah Pearson, Annelise Wilhite, Nathan Rubin, Britt K. Erickson
Vulvar Cancer: Evidence-based wound classification for vulvar surgery: Implications for risk adjustment I. Mert, W.A. Cliby, K.A. Bews, E.B. Habermann, S.C. Dowdy