Since surgery isn't getting any easier, why is reimbursement going down? An update from the SGO taskforce on coding and reimbursement.
In 2015, there was an 18% reduction in the Relative Value Units (RVUs) that the Center for Medicare and Medicaid Services (CMS) assigned to the Current Procedural Terminology (CPT) code 58571 (Laparoscopy, surgical, with total hysterectomy, for uterus 250g or less; with removal of tube(s) and/or ovary(s)→TLH+BSO). The other CPT codes for laparoscopic hysterectomy and laparoscopic supracervical hysterectomy (58541-58544 and 58570-58573) lost between 12 and 23% of their assigned RVUs. In 2016, the laparoscopic lymph node dissection codes 38570 (Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple), 38571 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy), and 38572 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), single or multiple) lost between 5.5 and 16.3% of their RVU's. The goals of this article from the Society of Gynecologic Oncology (SGO) Task force on Coding and Reimbursement are 1) to inform the SGO members on why CMS identified these codes as a part of their misvalued services screening program and then finalized a reduction in their payment levels; and 2) outline the role individual providers have in CMS' methodology used to determine the reimbursement of a surgical procedure.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States.
Shitanshu
S
Uppal
Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Abington, PA, United States.
Mark S
MS
Shahin
Galileo Consulting Group, Inc, Arlington, VA, United States.
Jill A
JA
Rathbun
Galileo Consulting Group, Inc, Arlington, VA, United States; Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States. Electronic address: bgoff@uw.edu.
Barbara A
BA
Goff
D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy / Q000191:economics*; D007349:Insurance, Health, Reimbursement; D010535:Laparoscopy / Q000191:economics*; D008197:Lymph Node Excision / Q000191:economics*; D006278:Medicare; D061646:Operative Time; D014481:United States