SGO Issues Sept 20, 2018

SGO Issues Sept. 20, 2018

Laparoscopic ovarian cancer staging and debulking | Mark S. Shahin, MD, FACS, FACOG and Kevin Holcomb, MD, FACOG
ECANA to host first conference during SGO Annual Meeting in Hawaii
Jonathan Niloff, MD, 1954-2018
Cervical cancer highlights in September 2018 Gynecologic Oncology
CMS provides information on Medicare claims affected by Hurricane Florence
Call for abstracts open for SGO 2019 Winter Meeting
Volunteers needed for 2020 SGO Annual Meeting Program Committee

Coding laparoscopic ovarian cancer staging and debulking | Mark S. Shahin, MD, FACS, FACOG and Kevin Holcomb, MD, FACOG

Mark S. Shahin, MD, FACS, FACOG

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 are likely performing laparoscopic comprehensive staging of ovarian cancer as well as laparoscopic ovarian debulking procedures, and you have probably noticed that there is currently no CPT code for laparoscopic omentectomy.

In the past, your billing options were 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 reimbursement without going through the appeals process (i.e., CPT code 49329) or inadequate reimbursement billing CPT code 49321 with the -22 modifier.

Kevin Holcomb, MD, FACOG

The SGO Coding and Reimbursement Taskforce took on this issue, and working with the American Congress of Obstetricians and Gynecologists (ACOG) applied for two new CPT codes, which were accepted. SGO and ACOG continued to work together on the process to have the codes valued for the assignment of relative value units (RVUs) and gather comments to finalize all of this with the Centers for Medicare and Medicaid Services (CMS) during the CY 2018 Medicare Physician Fee Schedule rulemaking process. Below are the descriptions and some important aspects of both codes that went into effect as of Jan. 1, 2018.

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. This code describes a laparoscopic completion of comprehensive staging in an ovarian cancer patient. The typical patient is one that underwent a prior hysterectomy and bilateral salpingo-oophorectomy.

  • 10-day global period
  • Never billed in conjunction with 58570-58572, 38570-38572, 49255, 49320-49322
  • Inpatient or outpatient hospital surgical procedure
  • Can be used for ovarian, uterine, peritoneal, cervical, or fallopian tube cancer
  • 20.0 work RVUs/33.59 total RVUs

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 only hospital surgical procedure
  • Can be used for ovarian, uterine, peritoneal, cervical, or fallopian tube cancer
  • 32.60 work RVUs/53.62 total RVUs

These two new 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.

SGO is now aware that the National Correct Coding Initiative (NCCI) put in some additional edits not related to the CPT codes listed in the parenthetical for the CPT 38573 code in conjunction with hysterectomy code 58571-3. The SGO Coding and Reimbursement taskforce, along with ACOG, is submitting an NCCI edit modification request to allow submission of 38573 with the typical total laparoscopic hysterectomy (TLH) codes. We will update the membership with the results of this submission when they become available.

Mark S. Shahin, MD, FACS, FACOG, is the Director of the Hanjani Institute for Gynecologic Oncology, Deputy Director of Asplundh Cancer Pavilion at Abington Hospital-Jefferson Health, in Abington, PA; and Professor of Obstetrics and Gynecology at Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia, PA.

Kevin Holcomb, MD, FACOG, is a gynecologic oncologist at the New York Presbyterian Hospital-Weill Cornell Medical College in New York City.

Want to learn more about coding for gynecologic oncology? SGO will host a 90-minute coding webinar, “Coding Bootcamp: Back to Basics,” on Tuesday, Sept. 25, at 7:00 p.m. ET/6:00 p.m. CT. Registration is available online. Cost is $50.

ECANA to host first conference during SGO Annual Meeting in Hawaii

Last month the Endometrial Cancer Action Network for African-Americans (ECANA), under the leadership of Principal Investigator Kemi Doll, MD, from the University of Washington, launched its website as the organization prepares to host its first annual ECANA Conference on March 15-16, 2019, held in conjunction with the 2019 SGO Annual Meeting on Women’s Cancer in Honolulu, HI.

Kemi Doll, MD

The ECANA Conference activities will include:

  • Educational workshops about endometrial cancer and racial disparities.
  • Training to become an ECANA peer educator, ambassador, and advocate in your community.
  • Learning and sharing strategies to survive and thrive through writing, movement, relationships, navigating the health care system, and more.
  • Discussion of priorities for research about endometrial cancer among black women
  • Lifelong connections with women from around the country who have had endometrial cancer.

“We do not want finances to be a barrier, so our goal is to fully fund the trip for all patient partners. We will collect information from the patients and arrange for their attendance,” said Dr. Doll. “We also really want SGO members interested in EC research—or patient partnerships—to attend. We have an exciting program planned, featuring interactive sessions with our patient partners and representatives from women’s health advocacy groups.”

After the conference, each attendee will be responsible for taking action in their home community to spread awareness about endometrial cancer and build connections to help ECANA grow.

Dr. Doll noted that since ECANA members first started meeting at the beginning of the year, ECANA’s patient partners were clear that the website must be a welcoming place for African-American women who’ve been diagnosed with endometrial cancer to find community and information.

“The website is designed to be a resource for women from the first day of diagnosis through survivorship,” said Dr. Doll. “We invite SGO members to incorporate the website into the information given to patients at their first visit–or even at the time of referral. My favorite section right now is called ‘Learn the Lingo,’ which is a quick reference animated dictionary of our medical jargon.”

The videos shared in the “Our Stories” section of the website were all contributed by Steering Group members, who sat down with Dr. Doll at 2018 SGO Annual Meeting to share their experiences.

“We will be recording more videos at the Hawaii meeting, and will use the ECANA website to share them,” said Dr. Doll. “We also have a way for women across the country who have stories to share to contact us via the website.”

Dr. Doll explained that ECANA’s members hope that the 2019 ECANA Conference will be the first of many in a long partnership with SGO. “The goal of this first conference is to build community for our patient partners, as well as to start the foundations of patient-researcher partnerships,” she said.

“The ECANA patient partners tell us that there is a profound lack of awareness, education, and positive messaging out there for Black women affected by this disease—and this cuts across all levels of income, education, and class,” said Dr. Doll. “We can start to fill that gap and harness their considerable energy to help to end this racial disparity. We need more research studies and more participation by Black women in those studies. This is a major function of ECANA—to build the bridge between these women and researchers—so study designs, recruitment, participation and results can be optimized and beneficial to all.”

Jonathan Niloff, MD, 1954-2018

Jonathan Niloff, MD

SGO regrets to announce the passing of gynecologic oncologist Jonathan Niloff, MD, of Boston, MA, who died last week at the age of 64 after being diagnosed with a rare cancer. According to his official obituary published in The Boston Globe, Dr. Niloff grew up in Montreal, Canada, with his parents and sisters, and his passion for fighting gynecologic cancer was inspired by his grandmother, Florence, who died of ovarian cancer.

After medical school at McGill University in Montreal, Dr. Niloff trained at the Brigham and Women’s Hospital in Boston, and was part of the team that discovered the CA-125 protocol. Dr. Niloff remained in Boston with his wife Rebecca (also a physician) whom he met in medical school, and in the three decades that followed, he worked at Brigham and Women’s, Deaconess and Beth Israel Medical Centers.

The obituary notes that “Jonathan published dozens of influential papers and trained a generation of surgeons. In his later years, Jonathan’s passion for health care moved beyond the operating room. He founded a company called Medventive, where he combined his medical experience with modern technology to develop software that enhanced patient safety and efficiency in health care settings. In his last few years, Jonathan moved to a consulting role supporting health care startups, which allowed him to spend more time with his growing family.”

In addition to his wife, Dr. Niloff leaves behind two adult children and two grandchildren. In lieu of flowers, those wishing to honor his legacy of curing the sick can best do so via donations to the Dana-Farber Cancer Institute, P.O. Box 849168, Boston, MA 02284.

Cervical cancer highlights in September 2018 Gynecologic Oncology

Historical Perspective: Twenty-first century cervical cancer management: A historical perspective of the Gynecologic Oncology Group/NRG Oncology over the past twenty years Charles A. Leath III, Bradley J. Monk

Gynecologic Oncology Tumor Board Presentation: Locally advanced cervical cancer complicating pregnancy: A case of competing risks from the Catholic University of the Sacred Heart in Rome R. De Vincenzo, L. Tortorella, C. Ricci, A.F. Cavaliere, G.F. Zannoni, M.G. Cefalo, G. Scambia, A. Fagotti

CMS provides information on Medicare claims affected by Hurricane Florence

The Centers for Medicare & Medicaid Services (CMS) has released a special edition of the Medicare Learning Network newsletter MLN Matters® for providers and suppliers who submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries in the States of North Carolina, South Carolina, and the Commonwealth of Virginia who were affected by Hurricane Florence. SGO continues to keep our affected members and their patients in our thoughts in the aftermath of this storm.

Call for abstracts open for SGO 2019 Winter Meeting

The call for abstracts is now open for the SGO 2019 Winter Meeting, Jan. 17-19, at the Resort at Squaw Creek, Olympic Valley near Lake Tahoe, CA. Early career gynecologic oncologists, radiation oncologists, medical oncologists, obstetricians and gynecologists, and allied health professionals involved in the care of patients who have gynecologic cancers are encouraged to attend this meeting. Registration and housing will open by the end of the month.

Volunteers needed for 2020 SGO Annual Meeting Program Committee

SGO is seeking Program Committee volunteers for the 2020 SGO Annual Meeting on Women’s Cancer® to be held March 28–31, 2020, at the Metro Toronto Convention Center, in Toronto, Canada. The deadline to apply is Oct. 12. Eligibility requirements and responsibilities are available on the online application. Direct any questions to SGO’s Education Department at