SGO Issues Nov. 30, 2017
SGO, FWC launch clinical trials video as teaching tool for patients
How would you code? Laparoscopic ovarian cancer staging and debulking | Kevin Holcomb, MD, FACOG
The Courage to Leave | Stephen L. Rose, MD
Gynecologic Oncology articles highlight clear cell ovarian cancer
SGO welcomes 16 new, 20 transitioning members
Early career members invited to become ‘Shark Bait’ at Annual Meeting
The SGO and Foundation for Women’s Cancer have released a video teaching tool for patients who might be interested in participating in gynecologic cancer clinical trials. This 19-minute program, “Gynecologic Cancer Clinical Trials: What This Means for You,” includes interviews with clinical trials patients describing their experiences as well as SGO member experts who debunk some of the misconceptions and myths surrounding clinical trials. The video part of a series of that SGO and FWC have introduced this year.
Some of the topics covered include:
- What is a clinical trial?
- When to consider a clinical trial
- Potential risks
- Potential benefits
- Phases of clinical trials
- Randomized trials and placebos
- What is a tumor board?
- Clinical trials cancer care team
- Impact on family life/time commitment
- Disparities in clinical trials
- Importance of research and patient participation
“Having a patient be able to view a video about clinical trials, which explains what they are, details about the process, and what it means for research, will liberate a lot of patients to have a better understanding and be more likely to embrace the concept of clinical trials because they’ll have more information,” said SGO President Laurel W. Rice, MD.
In addition to this program, there is a four-minute animated video, “Understanding Gynecologic Cancer Clinical Trials,” that specifically addresses the phases of clinical trials, and explains randomized trials and placebos. The MP4 files for both videos can be provided to SGO members who want to make the video available to their patients in their offices or waiting rooms. Contact SGO Senior Communications Manager Robyn Kurth at firstname.lastname@example.org to obtain these files.
Patient resources for gynecologic cancer clinical trials—including a glossary of terms and an updated brochure—are available on the SGO website.
If you are a gynecologic oncologist with a clinical interest in minimally invasive surgery, you have likely extended your laparoscopic skills to the management of women with ovarian cancer. If so, you have probably noticed that there is currently no CPT code for laparoscopic omentectomy and no way to bill laparoscopic comprehensive staging nor debulking procedures.
Presently your billing options are to use an unlisted CPT code (49329: unlisted laparoscopic procedure of the abdomen, peritoneum, omentum) or the CPT code for laparoscopy with biopsy (49321) appended with a 22 modifier to represent the additional work. Neither of these options adequately represent the work and time involved and may result in no (i.e., 49329) or inadequate (49321-22) reimbursement.
Fortunately, the SGO Coding and Reimbursement Taskforce took notice of this issue and petitioned CMS for novel CPT codes for both ovarian cancer staging and debulking. Both have been approved and have been available since Jan. 1, 2018. Below are the descriptions and some important aspects of both codes.
CPT code 38573 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple, peritoneal washings, single or multiple peritoneal biopsies, omentectomy, and diaphragmatic washings with or without biopsies.)
- 10 day global period
- Never billed in conjunction with 38570-38572, 49255, 49320-49322, 58570-58572
- Inpatient or outpatient
- Can be used for ovarian, uterine, peritoneal, cervical, or fallopian tube cancer
- 20 work RVU
CPT code 58575 (Laparoscopy, surgical, total hysterectomy; with or without salpingo-oophorectomy, unilateral or bilateral, with resection of malignancy (tumor debulking), with omentectomy) should be used to bill a laparoscopic ovarian cancer debulking.
- 90 day global period
- Never billed in conjunction with 49255, 49320-49321, 58570-58573, 58661
- Inpatient or outpatient
- Can be used for ovarian, uterine, peritoneal, cervical, or fallopian tube cancer
- 32.6 work RVU
These two novel CPT codes should simplify the coding and billing of minimally invasive procedures that are increasingly being performed for our ovarian cancer patients and ensure adequate reimbursement for the SGO membership.
Kevin Holcomb, MD, FACOG, is a gynecologic oncologist at the New York Presbyterian Hospital-Weill Cornell Medical College in New York City.
It was 4:00 p.m. My cases had finished early on a Monday and I was trying to catch up on the roughly 100 emails that had come in that day. I was still tired from a busy weekend of call, and it made focusing on anything difficult. As I read the same sentence six times over, I felt the sun on my back through my window. It was a beautiful spring day in Madison. There was no rain or wind and I knew there were still many hours of daylight. On a whim, I texted my friend Brian, who works in marketing at a local appliance company.
“Any chance you can play this afternoon?”
“I can leave right now!” he replied within seconds.
“Meet you at 5. I will call for a tee time” I answered.
I quietly shut down my computer, grabbed my bag and slinked down the hall to the back elevators, all the while hoping not to see another partner. I even considered for a moment, devising some reasonable excuse for why I was leaving early, but saw no one and averted that dilemma. I am certain had I seen a partner, they would not have cared where I was going. I am lucky to work with an amazing group of people who genuinely care about each other’s’ well-being, but leaving early still turns me in to an 8-year-old trying to steal a cookie from the pantry. Why do I feel the need to lie about taking care of myself? Because I have also been on the other side. I would love to tell you I have never cast a judgmental eye toward a colleague leaving early. The truth is, I have.
It is into this crucible that we have cast wellness.
We are a culture that values hard work. We lionize physicians who can seemingly do it all and are always available. But in this era of what the Accreditation Council for Graduate Medical Education (ACGME) calls “work compression,” where Relative Value Unit (RVU) targets have not changed despite new and different tasks such as Electronic Medical Record (EMR) use, patient satisfaction demands, multiple online safety and compliance trainings, we need to shelter wellness from becoming just another check on our to-do list.
How do we do this? We must change the culture that makes us feel guilty for leaving a few hours early. We must foster opportunities to take care of ourselves how we need to, when we need to. This culture will not change until we appreciate that everyone needs something different to be well. For me, golf is a mindfulness practice. At its core, mindfulness is about the quality of attention that you bring to an activity, not the activity itself. Golf engages my mind and body, allows me a few hours of work-free thought and re-energizes me. For others this might be aviation, cycling, gardening, or simply lying in a hammock, but all of these restorative activities must be met with encouragement, not judgment. Interestingly, while the age-old argument is that you have to work harder to accomplish more, science would tell us that sustained work without rest is actually less effective.
In the book Peak Performance: Elevate Your Game, Avoid Burnout and Thrive with the New Science of Success, authors Brad Stulberg and Steve Magness review the conditions required for sustained success. Chief among their findings is that productivity actually decreases without both short and long breaks away from work. Just as a muscle requires both stress and rest to grow, we require both to perform optimally in our professional lives. Rest is not a one size fits all model and we must allow our colleagues and ourselves reasonable flexibility to meet our needs. This culture change requires work from each of us, but especially from those of us leading divisions who need to model wellness by being more forgiving, more encouraging, and less judgmental. It requires all of us to have the courage to leave from the front elevators.
Stulberg B and Magness S. (2017). Peak Performance: Elevate Your Game, Avoid Burnout and Thrive with the New Science of Success. New York, NY.
Stephen L. Rose, MD, is the Director of the UW Gynecologic Oncology program at the University of Wisconsin School of Medicine and Public Health.
Gynecologic Oncology: Volume 147, Issue 2 (November 2017)
Lead Article: An evaluation of progression free survival and overall survival of ovarian cancer patients with clear cell carcinoma versus serous carcinoma treated with platinum therapy: An NRG Oncology/Gynecologic Oncology Group experience Kate E. Oliver, William E. Brady, Michael Birrer, David M. Gershenson, Gini Fleming, Larry J. Copeland, Krishnansu Tewari, Peter A. Argenta, Robert S. Mannel, Angeles Alvarez Secord, Jean-Marie Stephan, David G. Mutch, Frederick B. Stehman, Franco M. Muggia, Peter G. Rose, Deborah K. Armstrong, Michael A. Bookman, Robert A. Burger, John H. Farley
Editorial: Clear Cell Ovarian Cancer: Optimum Management and Prognosis Remain Hazy John K. Chan, Daniel S. Kapp
From September through October 2017, 16 new members joined the Society of Gynecologic Oncology and an additional 20 members transitioned to the next membership level. SGO congratulates the following new and transitioning members:
Transitioning Full Members
Gwyn Richardson, MD
Bunja J. Rungruang, MD
Jennifer M. Scalici, MD
Transitioning Candidate Members
Joao M. Casanova Goncalves, MD
Laura M. Divine, MD
Michelle A. Glasgow, MD
Natalie S. Godbee, DO
Laura Huffman, MD
Nathaniel L. Jones, MD
Josephine Kim, MD
Elena Pereira, MD
Rachel Ruskin, MD
Erin J. Saks, MD
Sumer Wallace, MD
Transitioning Fellow-In-Training Members
Soledad Jorge, MD
Maureen Roberts, MD
Maria P. Ruiz, DO
Sharif Sakr, MD
Transitioning Senior Members
Arlan F. Fuller, Jr. MD
John A. Carlson, Jr. MD
New Full Members
Christine M. Fisher, MD, MPH
Andrzej Piotr Kudelka, MD
New Candidate Member
Robert Martin Ore, MD
New Associate Member
William Brady, PhD
New Fellow-in-Training Member
Melissa Lippitt, MD
New Resident/Student Members
Caitlin Carr, MD
Jessica DiSilvestro, MD
Nicole B. Gaulin, MD
Ross Harrison, MD
Karolina Kilowski, DO
Pamela N. Peters, MD
Lauren Rose Scanlon, MD
Mali Schneiter, MD
Zhen Ni Zhou, MD
New Allied Members
Virginia A. Archer, BS, BSN, MSN
Justine Bucknam, RN, MSN, ARNP
Fellow and early career members are invited to submit ideas that would benefit the entire SGO membership, and see which one of their mentors will “take the bait.” Proposals are due Jan. 15, 2018. Finalists, to be named by Feb. 5, will present their proposals during the SGO Shark Bait Educational Forum on Sunday, March 23, from 5:00 p.m. to 6:30 p.m. during the SGO Annual Meeting on Women’s Cancer. The winning team, as chosen by the Sharks, can choose the mentor with whom they wish to work from the pool of Shark mentors. The winning team will also receive $5,000 cash to help implement their proposal, and free registration to the 2019 SGO Annual Meeting in Honolulu, HI, for each team member.