SGO Issues Feb. 22, 2018
SGO Winter Meeting breaks attendance record 2nd year in a row
Call for abstracts for Gynecologic Oncology special issue
Saying Goodbye to a Patient | Larry Puls, MD
Coding for cytoreduction with exenteration | Andrew W. Menzin, MD, MBA, FACOG, FACS
February 2018 Gynecologic Oncology focuses on GTD
The SGO Winter Meeting, held Feb 8-10, at the Westin Snowmass Resort near Aspen, CO, broke an attendance record for the second year in a row with 257 attendees. The meeting also had the highest number of exhibitors—15 in all—at a Winter Meeting. A total of 32 abstracts were presented, with five oral abstracts and 27 posters. Photos from the 2018 SGO Winter Meeting are available on SGO’s Flickr account.
Elsevier, publisher of Gynecologic Oncology, has opened a call for abstracts for a special issue on “Health Services Research and Outcomes in Gynecologic Oncology.” Elsevier is inviting clinicians, health policy and public health experts, economists, and other investigators who are engaged in Health Services Research to submit an original manuscript reporting their results for peer review. The deadline for submission is March 30.
The special issue guest editors are Laura Havrilesky, MD, from Duke University in Durham, NC; and J. Alejandro Rauh-Hain, MD, from The University of Texas MD Anderson Cancer Center in Houston, TX.
This issue of Gynecologic Oncology will provide an opportunity for experts in the field of Health Services Research to contribute gynecologic cancer-specific studies related to screening, outcomes, health-care resource utilization, and treatment modalities (including radiotherapy, chemotherapy, targeted and biologic therapies), surgical approaches, and palliative and end-of-life care.
Relevant topics include (but are not limited to):
A) Health Economics Research:
- Cost-effectiveness analysis
- Cost–utility analysis
- Comparative cost analysis
- Analysis of value-based care
B) Cancer Outcomes Research:
- Comparative effectiveness: How interventions perform in the complex and variable context of real-world use and practice
- Studies focused on translating research findings into clinical practice
- Variations in care (e.g., based on ethnicity, culture, provider, or geography) and their determinants
C) Quality Improvement Strategies and Quality of Care Assessment:
- Development and implementation of best practices
- Process of care performance measures and long-term outcomes
- Patient-reported outcomes
- Delivery of care
D) Evaluation of the Impact of Current Health Policies on Outcomes.
Abstracts should be submitted for review to Linda Brooks, Publishing Support & Insights Specialist for Gynecologic Oncology via email to: firstname.lastname@example.org.
I stand at the door—afraid. Take a deep breath. Just another room; one I have been in a thousand times before. Inside a bed, a bathroom, an IV pole, a friend. And while I stand there, my angst grows over the unrevealed information. Still frozen in the hallway, I cannot reach out and touch the door handle. You have to go in.
My conscience compels me across the threshold. There she is on the bed, under the covers. The IV pump making its purring sound. She looks so peaceful. I could not find a more difficult way to start the day. Even now, the important words remain jumbled in my mind. I wish there were another way. But there are no other volunteers. When I look around, pressure mounts, seeing the patient surrounded by an entourage of residents and students begging for some kind of wisdom or insight to do that which screams impossible. Fear overtakes me.
I sit on the side of her bed and touch her on the shoulder. She turns and smiles at me. My friend — this woman who won my heart with her bravery, her kindness, her fortitude. Her sense of humor pops into my mind. All the laughs we had. All the cries we had. They are all in the front of my eyes. You must tell her.
The first words, the easy ones, float delicately from my mouth. I recount all the places we’ve been. Surgery, chemotherapy, surgery again, back to chemo—a game of leap frog… But now, as the hard words are inching up my throat, something unavoidable happens. My eyes speak first—teardrops fall. I see her grasping my anguish, my vacillating heart. I was never good at poker. She knows. The secret has leaked out, albeit unspoken, but audible nonetheless. I see her start to weep. A cancerous checkmate.
I realize this is where life took me as an oncologist. We are not on the sidelines of life, watching everything from afar, but we have been thrust into trenches too often wrought with sorrow. For good or for bad, we are by definition, engaged. And yes, I struggle with that not uncommonly.
Is there a blessing? Our broken hearts remind us of the joy of life, the joy of other souls, even when they are packaged with agonizing pain, carving out deep scars—but healthy and needed ones. Life is a gift and we are blessed to be allowed to savor that gift. Never forget that!
Leaving her room, I reflected on what we do for a living. And I acknowledge yet again that in my own individual life, without my faith, I could not be sustained in such a wrenching moment as this. It upholds me and commands me, to stay in the trenches and pour my heart into the lives of those entrusted to me. So, my encouragement to all of us is that we absorb our fragile emotions, calm our saddened souls, and regroup to serve where we are called.
Larry Puls, MD, is a gynecologic oncologist in Greenville, SC.
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Ultra-radical surgery is sometimes necessary to accomplish successful cytoreduction of gynecologic malignancy. Variations of en-bloc resection include anterior, posterior, and total pelvic exenteration (with further qualification indicating either supra-levator or infra-levator dissection). The current CPT coding options do not provide for differentiation between these similar but different procedures.
CPT 58240 (Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube[s], with or without removal of ovary[s], with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof) serves as the single option to describe an exenterative procedure. Based upon the description, this code can be used for all variations of the procedure.
CPT codes for additional procedures may be billed in addition to CPT code 58240 (e.g., lymphadenectomy, resection of peritoneal tumor). Please check the National Correct Coding Initiative (NCCI) edits when billing multiple CPT codes on a single claim. In the case of CPT code 58240, several edit pairs can be found here.
Attaching the narrative of the surgical procedure may be helpful in the billing submission. Should the procedure not align with the description, it may be necessary to append a reduced services modifier (-52) to clarify the precise nature of the operation.
Associated details of CPT 58240:
- It is assigned a 90-day global period
- Never billed in conjunction with other hysterectomy procedures
- Typical patient is an “Inpatient Stay.”
- Can be used for ovarian, uterine, peritoneal, cervical, or fallopian tube cancer
- 49.33 Work RVUs and 83.79 Total RVUs for 2018.
- National Average Medicare Payment to a physician is $3,016.41
Andrew W. Menzin, MD, MBA, FACOG, FACS is Chief of Gynecologic Oncology, Northwell Health Physician Partners, Central Region and Professor of Obstetrics & Gynecology, Zucker School of Medicine at Hofstra/Northwell
The February issue of Gynecologic Oncology contains several articles on gestational trophoblastic disease (GTD), including articles on choriocarcinoma, gestational trophoblastic neoplasia and molar pregnancy.
- Nonmetastatic Excised Gestational Choriocarcinoma: To Treat or Not to Treat
Anna E. Strohl, John R. Lurain
- Is chemotherapy always necessary for patients with nonmetastatic gestational trophoblastic neoplasia with histopathological diagnosis of choriocarcinoma?
Antonio Braga, Vanessa Campos, Jorge Rezende Filho, Lawrence H. Lin, Sue Yazaki Sun, Christiani Bisinoto de Souza, Rita de Cássia Alves Ferreira da Silva, Elaine Azevedo Soares Leal, Eduardo Silveira, Izildinha Maestá, José Mauro Madi, Elza H. Uberti, Maurício Viggiano, Kevin M. Elias, Neil Horowitz, Ross S. Berkowitz
Gestational Trophoblastic Neoplasia
- The efficacy and safety of first-line single-agent chemotherapy regimens in low-risk gestational trophoblastic neoplasia: A network meta-analysis
Jun Li, Shufen Li, Hinlin Yu, Jieyu Wang, Congjian Xu, Xin Lu
- What is the optimal duration of human chorionic gonadotrophin surveillance following evacuation of a molar pregnancy? A retrospective analysis on over 20,000 consecutive patients
Christopher Coyle, Dee Short, Lauren Jackson, Neil J. Sebire, Baljeet Kaur, Richard Harvey, Philip M. Savage, Michael J. Seckl