Physician's Coding Strategist
Winners and losers in the RVU update
Final values coming Nov. 1
The American Medical Association’s Specialty Society Relative Value Update Committee (RUC) has recommended a wide variety of procedural coding changes that have been implemented by Medicare. Following is a summary of the actions, categorized by specialty. The full list as it appears in the Federal Register can be found at www.hcfa.gov/regs/pfs/fr08jn01.pdf. The final RVUs are expected to be published Nov. 1.
Vascular Surgery
The Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery requested increases in work RVUs for 95 codes.
RUC recommendation: Of these, the RUC recommended increases for 91 codes, a decrease for one code, and no changes for three codes.
General Surgery/Colon and Rectal Surgery
The American Society of General Surgeons submitted 55 codes it believed to be undervalued. The society recommended increased work RVUs for each service.
RUC recommendation: RUC recommended that the work RVUs for the following codes be increased: code 36489, placement of central venous catheter (subclavian, jugular, or other vein (e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy)), percutaneous, age 2 years or under (2.50) to correct a rank-order anomaly; 60100, biopsy thyroid, percutaneous core needle (1.56), to appropriately reflect the work involved and fit in the range of biopsy codes; and 31600, tracheostomy, planned (separate procedure) (7.18), based on the building-block approach and the comparison to similar procedures.
Medicare’s response: Accepted all the RUC’s recommendations.
Thoracic Surgery
The RUC reviewed 89 thoracic surgery codes. Of these, it recommended increases for 44 codes, no changes for 43 codes, and decreases for 2 codes. The recommendations, categorized by family, are as follows:
Family 1: The RUC recommended no increase in work RVUs for codes 32000, 32005, 32020, 32035, 32225, 32602, 32651, and 32652. The RUC recommended increases in work RVUs for codes 32220 (24.00) and 32320 (24.00).
Family 2: The RUC recommended increases for codes 32440 (25.00) and 32480 (23.75). The RUC also recommended increases in work RVUs for codes 32100 (15.24) and 32110 (23.00).
Family 3: The RUC recommended increases in codes 32482 (25.00) and 32500 (22.00), based on the median work RVUs for each code.
Family 4: The RUC recommended no increase for code 32655 but proposed increases for codes 31600 (7.18) and 32500 (22.00).
Family 5: The RUC recommended increases for code 38746 (4.89) based on the work RVU for 38747, but recommended no increases for codes 39010, 39220, or 39400.
Family 6: The RUC agreed with the Society of Thoracic Surgeons analysis of work for codes 43107 (40.00) and 43112 (43.50).
Family 7: The RUC recommended an increase for codes 43117 (40.00) and 43122 (40.00).
Family 8: The RUC recommended no increase for codes 31625 or 31645.
Family 9: The RUC recommended increases for codes 33400 (28.50), 33405 (35.00), 33406 (37.50), 33411 (36.25), 33412 (42.00), and 33413 (43.50), based on a building-block approach that used code 33405 as the anchor code for this family.
Family 10: The RUC recommended increases for codes 33426 (33.00), 33427 (40.00), 33430 (33.50), and 33475 (33.00), based on a building-block approach that used code 33427 as the anchor code for this family.
Family 11: The RUC recommended increases for codes 33510 (29.00), 33511 (30.00), 33512 (31.80), and 33513 (32.00), based on a building-block approach that used code 33512 as the anchor code for the family. The RUC also recommended decreases for codes 33514 (32.75) and 33516 (35.00).
Family 12: The RUC recommended no increases for add-on codes 33517, 33518, 33519, 33521, 33522, 33523, and 33530, because it believes they were inappropriately surveyed as 90-day global procedure codes and the results were not reliable.
Family 13: The RUC recommended increases in work RVUs for codes 33533 (30.00), 33534 (32.20), 33535 (34.50), and 33536 (37.50), based on a building-block approach that used code 33533 as the anchor code for the family of codes.
Family 14: The RUC recommended increases in work RVUs for codes 33860 (38.00), 33861 (42.00), 33863 (45.00), and 33870 (44.00) based on a building-block approach that used code 33860 as the anchor code for the family.
Family 15: The RUC recommended no increases in work RVUs for codes 33750, 33820, and 33840 due to a lack of compelling evidence to support an increase.
Family 16: The RUC recommended an increase in code 33660 (30.00) based on intraservice work RVUs for 33401 and pre- and postservice work RVUs for 33641.
Family 17: The RUC recommended no increase in work RVUs for code 33415 because it did not believe that the typical patient for this procedure had changed.
However, the RUC recommended an increase in work RVUs in code 33681 (30.61) because the intraservice intensity of 33681 is more complex than it was five years ago.
Family 18: The RUC recommended increases in codes 33615 (34.00), 33670 (35.00), and 33730 (34.25) based on a comparison to code 33412.
Family 19: The RUC recommended increases in work RVUs for codes 33611 (34.00), 33612 (35.00), 33694 (34.00), and 33697 (36.00).
Family 20: The RUC recommended an increase in code 33617 (37.00) after comparing it to code 33412 and noting that 33617 has greater intraservice time and higher intensity ranking than code 33412.
Family 21: The RUC recommended an increase in code 33619 (45.00) after comparing it to codes 48150 and 62530.
Family 22: The RUC recommended an increase in code 33506 (35.50) to preserve proper rank order within this family. The RUC recommended an increase in code 33770 (37.00) after finding that the work of this code is more than that of the comparison code 33697. The RUC recommended an increase in code 33778 (40.00) after comparing it to 33870 and 33412, which are less intense procedures. The RUC recommended an increase in code 33780 (41.75) based on a comparison to 33778. 33780 involves more work and warrants an additional 1.75 RVUs due to the additional 35 minutes of intraservice time.
Family 23: The RUC recommended an increase in code 33786 (39.00) after comparing it to 33412, which has less time and intensity. Given the limited specialty survey data, the RUC believed that the recommended increase in code 33919 to 40.00 work RVUs was warranted but that the survey did not support a value higher than the median survey value.
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