SGO Issues Nov 17, 2016

sgo-issues

SGO Issues Nov. 17, 2016

Allied Workshop keynote to focus on resiliency
SGO supports ‘well-woman’ pelvic exams
How Would You Code? Endometrial Cancer Part 1: Hysterectomy
Deadline extended to Nov. 30 for Claudia Cohen Research Foundation Prize
Volunteer for an SGO committee
SGO surgeons, staff earn over $22K for Race

Allied Workshop keynote to focus on resiliency

Lou Lacey

Lou Lacey

With a focus on preventing compassion fatigue amongst professional caregivers, Lou Lacey, Director of Emotional Wellness at Children’s of Alabama in Birmingham, AL, will present the keynote address on “Self-Compassion and Resiliency” at the Allied Health Professionals Workshop in Chicago Dec. 3-4.

“Self-care is at the heart of it and yet the very idea of that is laughable to most professional caregivers,” Lacey said. “We’re going to talk about how to fall in love with our careers all over again.”

Having worked with health care professionals in various settings, including oncology, Lacey acknowledged that there are some caregiving challenges faced by allied care professionals that physicians might not experience.

“Allied professionals typically have less authority than physicians and don’t have as much influence regarding things that might influence their well-being such as scheduling and time-off,” she said. “Generally speaking they aren’t afforded the same level of respect.”

Lacey hopes that at the end of her Dec. 3 presentation, Allied Workshop attendees will have a greater appreciation for the work that they do. “I hope they will walk away feeling encouraged,” she said. “I hope they will walk away remembering that their hard work makes the world a better place.”

Registration and housing is still open for the Allied Workshop through the SGO website.

SGO supports ‘well-woman’ pelvic exams

The SGO Board of Directors has approved the release of the Society’s official Position Statement on Pelvic Examinations, recommending that “providers continue to offer pelvic exams to every patient presenting for a well-woman examination.” The SGO statement is in response to an earlier US Preventive Services Task Force (USPSTF) statement that concluded “the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women.”

Expressing concern that the USPSTF statement could be misinterpreted as a recommendation against pelvic exams, the SGO emphasizes the pelvic exam’s important role as the only tool a provider has to examine the female reproductive system.

According to the statement, “Screening pelvic exams should be offered to women even if ‘asymptomatic,’ to ensure that optimal evaluation is provided for women who may not recognize that their symptoms are important or abnormal, or may be embarrassed to volunteer symptoms involving their reproductive health. The SGO emphasizes the importance of offering this examination as part of a comprehensive evaluation of the entire patient, without neglecting an entire organ system.”

How Would You Code? Endometrial Cancer Part 1: Hysterectomy

There are a number of options for the type of hysterectomy and lymphadenectomy performed for the treatment of endometrial cancer. What are the correct codes for the various procedures that may be performed?

Historically, an abdominal hysterectomy with sampling of the pelvic and aortic lymph nodes was frequently performed. The CPT code and wRVUs for this procedure (58200) are shown in the Table, which lists the wRVUs assigned by CMS for 2016 as well as their values for 2014.

When an abdominal hysterectomy with a full pelvic lymphadenectomy with or without an aortic node dissection was performed, an edit in the CPT manual recommended coding this procedure as 58210.

With the transition to minimally invasive hysterectomies, laparoscopic codes have been adapted to the analogous open procedures. A laparoscopic (or robotic) hysterectomy with pelvic lymph node dissection requires two codes; 58571 (or 58572 for uteri >250gm) in conjunction with 38571 (bilateral pelvic lymphadenectomy) or 38572 (bilateral pelvic lymphadenectomy and aortic node sampling). The lymphadenectomy code utilized requires the multiple procedure modifier 51, and will be reimbursed at 50%.

Recently, laparoscopic sentinel pelvic lymph node removal has become more frequent.  For this procedure, the coding for the hysterectomy is the same. However, for injection of the cervix with dye the CPT add on code 38900 should follow the CPT used for the type of lymphadenectomy performed.

An example of billing for a laparoscopic hyst/bso/sentinel nodes is given below. The code with the highest RVU value should always be listed first.  For a selective lymphadenectomy the CPT code 38570 is applicable (wRVU was reduced by 50% to reflect the reduction in reimbursement).  The third code is an “add on” code and therefore doesn’t require the 51 modifier and should be reimbursed at the full wRVU listed.

It should be noted that although CMS has adjusted the wRVUs downward over the past year or two for the minimally invasive procedures used to treat endometrial cancer, the DRG payments to the hospital for CPT 58571 have increased this past year, from $3779 in 2015 to $6861 in 2016.

Table

Procedure CPT wRVU* (2014)
Abdominal hyst/node sampling 58200 23.10 (23.10)
Abdominal hyst/pelvic node dissection 58210 30.91 (30.91)
Laparoscopic hyst 58571 15 (17.69)
Laparoscopic pelvic node dissection 38571 12 (14.76)
Laparoscopic pelvic and aortic node dissection 38572 15.6 (16.94)
Laparoscopy with retroperitoneal lymph node sampling (biopsy)
(single or multiple)
38570 8.49 (9.34)
Identification of sentinel lymph nodes (includes injection of cervix) 38900 2.5 (2.5)
Example: Robotic hyst/bso/sentinel nodes for uterus less than 250gm 58571 15
38570 -51 4.25**
38900 2.5
Total wRVU 21.75

Table

*Source:
2016 National Physician Fee Schedule Relative Value File January Release
2014 National Physician Fee Schedule Relative Value File January Release

Submitted by Brent DuBeshter, MD, at the University of Rochester in Rochester, NY.  In next month’s SGO Issues, “How Would You Code: Endometrial Cancer Part 2” will focus on coding for lymphadenectomy.

Deadline extended to Nov. 30 for Claudia Cohen Research Foundation Prize

The application deadline for the Claudia Cohen Research Foundation Prize for Outstanding Gynecologic Cancer Researcher has been extended to Wednesday, Nov. 30. This $50,000 annual prize is awarded to an individual in recognition of his or her outstanding contributions to research improving the care of women with gynecologic cancer.

Volunteer for an SGO committee

SGO is seeking volunteers to serve on committees for the 2017 program year. The committees listed on the SGO website will serve a joint purpose for the SGO and the Foundation for Women’s Cancer (FWC). To find out which committee is right for you, please review the committee descriptions and fill out the 2017 Committee Volunteer Form. The call for volunteers closes Dec. 5, 2016. For more information, please email SGO Manager of Governance Jennifer Ocampo-Martinez at jennifer.ocampo@sgo.org or call (312) 676-3916.

SGO surgeons, staff earn over $22K for Race

The SGO Surgeons Team, combined with several SGO member sub-teams and the Chicago-based SGO Staff, have raised more than $22,000 so far to support the foundation’s mission based programs during the National Race to End Women’s Cancer on Nov. 6 in Washington, DC. Donations are still being accepted through Dec. 31.

The SGO Surgeons Team and the SGO member sub-teams (MSKCC Cancer Crushers, OK Stephenson Cancer Center, UCSD GynOnc, Robert C Park Society, Ohio State University, Hopkins Ova Achievers) raised a combined amount of $18,057.

The top-earning surgeons teams were:

  • SGO Surgeons Team: $7,548
  • MSKCC Cancer Crushers: $6,846
  • Hopkins Ova Achievers: $3,163
  • OK Stephenson Cancer Center: $500

The SGO staff team, Windy City Warriors for Women, raised an additional $4,200 for the Race, bringing the current total up to $22,257. Between all of these groups, a total of 176 SGO Surgeons registered for the Race.

Stephanie Blank, MD

Stephanie Blank, MD

Rob Guintoli, MD

Rob Guintoli, MD

Amongst the Race participants, Stephanie Blank, MD, of NYU Langone Medical Center in New York City, earned the Fastest Female Surgeon award, with a time of 28:35 for the 5K, while Robert Giuntoli, MD, of Penn Medicine in Philadelphia, won the Fastest Male Surgeon award with a time of 21:00.