[Federal Register Volume 66, Number 111 (Friday, June 8, 2001)]
[Notices]
[Pages 31028-31084]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-14336]
[[Page 31027]]
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Part III
Department of Health and Human Services
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Health Care Financing Administration
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Medicare Program; Five-Year Review of Work Relative Value Units Under
the Physician Fee Schedule; Notice
Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 /
Notices
[[Page 31028]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[HCFA-1170-PN]
RIN 0938-AK56
Medicare Program; Five-Year Review of Work Relative Value Units
Under the Physician Fee Schedule
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Proposed notice.
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SUMMARY: This proposed notice discusses changes to work relative value
units (RVUs) affecting payment for physicians' services. Section
1848(c)(2)(B)(i) of the Social Security Act requires that we review
RVUs no less often than every 5 years. This is the second review of
work RVUs since we implemented the physician fee schedule on January 1,
1992. These work RVUs are proposed to be effective for services
furnished beginning January 1, 2002.
DATES: To be assured of consideration, we must receive comments at the
appropriate address, as provided below, no later than 5 p.m. on August
7, 2001.
ADDRESSES: Mail written comments (1 original and 3 copies) to the
following address only: Health Care Financing Administration,
Department of Health and Human Services, Attention: HCFA-1170-PN, P.O.
Box 8013, Baltimore, MD 21244-8013.
Please allow sufficient time for mailed comments to be timely
received in the event of delivery delays. If you prefer, you may
deliver your written comments by courier (1 original and 3 copies) to
one of the following addresses:
Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW.,
Washington, DC 20201,
or
Room C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-8013
Comments mailed to the above addresses may be delayed and received
too late to be considered.
Because of staff and resource limitations, we cannot accept
comments by facsimile (FAX) transmission. In commenting, please refer
to file code HCFA-1170-PN. Comments received timely will be available
for public inspection as they are received, generally beginning
approximately 3 weeks after publication of a document at the
headquarters of the Health Care Financing Administration, 7500 Security
Boulevard, Baltimore, Maryland, on Monday through Friday of each week
from 8:30 a.m. to 5 p.m. Please call (410) 786-7197 to make an
appointment to view the public comments.
FOR FURTHER INFORMATION CONTACT:
Jim Menas, (410) 786-4507.
Rick Ensor, (410) 786-5617.
Diane Milstead, (410) 786-3355.
Marc Hartstein (Regulatory Impact Analysis), (410) 786-4539.
Supplementary Information
Copies: To order copies of the Federal Register containing this
document, send your request to: New Orders, Superintendent of
Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date
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number and expiration date. Credit card orders can also be placed by
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Federal Depository Libraries and at many other public and academic
libraries throughout the country that receive the Federal Register.
This Federal Register document is also available from the Federal
Register online database through GPO Access, a service of the U.S.
Government Printing Office. The Website address is: http://www.access.gpo.gov/nara/index.html.
To assist readers in referencing sections contained in the
preamble, we are providing the following table of contents:
Table of Contents
I. Background
A. Legislative History
B. Published Changes to the Physician Fee Schedule
C. Current Proposed Notice
D. The 5-Year Review Process
II. Discussion of Comments and Decisions
A. Review of Comments
B. Discussion of Comments by Clinical Area
1. Vascular Surgery
2. General Surgery/Colon and Rectal Surgery
3. Thoracic Surgery
4. Orthopedic Surgery
5. Ophthalmology
6. Urology
7. Obstetrics/Gynecology
a. Specialty Comments
b. Other Concerns
8. Gastroenterology
9. Pulmonary Medicine/Critical Care
10. Cardiology
11. Pediatrics
12. Pediatric Surgery
13. Radiology
14. Plastic Surgery
C. Other Comments
1. Anesthesia Services
2. Spine Injection Procedures
3. Biofeedback
4. Surgical Management of Burn Wounds
5. Transplantation
6. Arthroscopy Services
7. Wheelchair Management
8. Psychological Testing
9. Podiatric Services
D. Other Issues
1. Critical Care Services in a Global Period
2. Codes Referred to CPT
3. Budget Neutrality
4. Calculation of Practice Expense and Malpractice Relative
Value Units
5. Nature and Format of Comments on Work Relative Value Units
III. Collection of Information Requirements
IV. Response to Comments
V. Regulatory Impact Analysis
Because of the many organizations and terms to which we refer by
acronym in this proposed notice, we are listing these acronyms and
their corresponding terms in alphabetical order below:
AANA Arthroscopy Association of North America
AAO American Academy of Opthalmology
AAP American Academy of Pediatrics
ABA American Burn Association
ACG American College of Gastroenterology
ACOG American College of Obstetrics and Gynecology
ACR American College of Radiology
ACS American College of Surgeons
AGA American Gastrointestinal Association
AMA American Medical Association
APMA American Podiatric Medical Association
APSA American Pediatric Surgical Association
APTA American Physical Therapy Association
ASA American Society of Anesthesiologists
ASCRS American Society of Colon and Rectal Surgeons
ASGE American Society for Gastrointestinal Endoscopy
ASPS American Society of Plastic Surgery
ASTS American Society for Transplant Surgeons
AUA American Urological Association
BBA Balanced Budget Act
CPT Current procedural terminology
CY Calendar year
ERCP Endoscopic retrograde cholangio-pancreatography
FDA Food and Drug Administration
FR Federal Register
GAF Geographic adjustment factor
GCPI Geographic practice cost index
GPO Government Printing Office
[[Page 31029]]
HCFA Health Care Financing Administration
HCPAC Health Care Professionals Advisory Committee
HCPCS HCFA Common Procedure Coding System
HHS Health and Human Services
IWPUT Intra-service work per unit of time
MEI Medicare economic index
MQSA Mammography Quality Standards Act of 1992
MSA Metropolitan statistical area
PE Practice expense
PEAC Practice Expense Advisory Committee
RFA Regulatory Flexibility Act
RIA Regulatory impact analysis
RUC [AMA's Specialty Society] Relative [Value] Update Committee
RVU Relative value unit
STS Society of Thoracic Surgeons
SVS Society for Vascular Surgery
I. Background
A. Legislative History
Since January 1, 1992, Medicare has paid for physician services
under section 1848 of the Social Security Act (the Act), ``Payment for
Physicians'' Services.'' This section contains three major elements,
(1) a fee schedule for the payment of physicians' services; (2) a
sustainable growth rate for the rates of increase in Medicare
expenditures for physicians' services; and (3) limits on the amounts
that nonparticipating physicians can charge beneficiaries. The Act
requires that payments under the fee schedule be based on national
uniform relative value units (RVUs) based on the resources used in
furnishing a service. Section 1848(c) of the Act requires that national
RVUs be established for physician work, practice expense, and
malpractice expense.
Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments
in RVUs may not cause total physician fee schedule payments to differ
by more than $20 million from what they would have been had the
adjustments not been made. If this tolerance is exceeded, we must make
adjustments to the conversion factors (CFs) to preserve budget
neutrality.
B. Published Changes to the Physician Fee Schedule
In the July 2000 proposed rule (65 FR 44177), we listed all of the
final rules published through November 1999, relating to updates to the
RVUs and revisions to the payment policies under the physician fee
schedule. In the November 2000 final rule (65 FR 65376), we finalized
the calendar year (CY) 2000 interim physician work RVUs and issued new
interim work RVUs for new and revised codes for CY 2001. The final rule
also discussed the activities underway with respect to the second 5-
year refinement of work RVUs.
C. Current Proposed Notice
This proposed notice discusses changes to work RVUs affecting
payment for physicians' services. Section 1848(c)(2)(B)(i) of the Act
requires that we review RVUs no less often than every 5 years. We
implemented the physician fee schedule effective for services furnished
beginning January 1, 1992: the first 5-year review of work was
initiated in December 1994 and was effective for services furnished
beginning January 1, 1997. The revisions proposed in this notice are
subject to a 60-day public comment period. We will review public
comments, make adjustments as appropriate, and include revised values
in our physician fee schedule final rule, to be published by November
1, 2001, effective for services furnished beginning January 1, 2002.
D. The 5-Year Review Process
We initiated the second 5-year review by soliciting public comments
on potentially misvalued work RVUs for all services in the 2000
physician fee schedule in our November 2, 1999 final rule (64 FR
59427). To allow sufficient time for recommendations, we provided a
120-day comment period. We included a discussion of the activities
underway with respect to the second 5-year refinement of work RVUs in
the July 17, 2000 proposed rule (65 FR 44201).
We received comments from approximately 30 specialty groups,
organizations, and individuals involving over 900 CPT and HCPCS codes.
We also received comments on the proposed process for the 5-year
review. As we indicated in the November 2, 1999 final rule and in the
July 17, 2000 proposed rule, we shared these comments with the AMA
Specialty Society Relative Value Update Committee (RUC). The RUC was
formed in November 1991 and grew out of a series of discussions between
the AMA and major national medical specialty societies. The work of the
RUC is supported by the RUC Advisory Committee, which is made up of
representatives of 100 specialty societies in the AMA's House of
Delegates.
The RUC currently makes recommendations to us on RVUs for new and
revised CPT codes (hereafter referred to as codes). This process was
used during the first 5-year review, and we believe that it was
beneficial. We indicated that we believe the perspective of the RUC is
helpful because of its experience in recommending RVUs for the codes
that have been added to, or revised by, the CPT panel since we
implemented the physician fee schedule in 1992. By virtue of its
multispecialty membership and consultation with specialty societies,
the RUC involves the medical community in formulating its
recommendations. For codes used only by non-physician practitioners,
the Health Care Professionals Advisory Committee (HCPAC), a companion
to the RUC, has made recommendations to us.
As we stated in the first 5-year review, we retain the
responsibility for analyzing the comments and recommendations,
developing the proposed rule, evaluating comments on the proposed rule,
and deciding whether to revise RVUs.
After we sent the RUC the comments we received on potentially
misvalued services, the RUC identified specialty societies interested
in making presentations concerning those misvalued services. In making
presentations to the RUC, specialty societies compiled data using a
standard survey instrument whereby respondents compared the surveyed
service with similar ``reference'' services that have established,
agreed upon work values. Respondents were asked to estimate the work
for the survey code, the time to perform pre-, intra-, and postservice
activities, and the technical skill, risk, and judgement involved with
performing the service. Postservice activities were broken down into
hospital and office visits and were assigned an appropriate evaluation
and management code by the respondent. Each specialty society selected
the physician sample that was surveyed. A minimum of 30 responses was
required by the RUC for the survey to be considered valid.
For this 5-year review, the RUC permitted a specialty society to
use a ``minisurvey'' for some codes if the number of codes a specialty
was reviewing was extremely high. These minisurveys required less
information from the respondent but were similar in design.
Some specialty societies used a ``building-block'' approach to
validate the survey results for surgical services. In constructing the
building blocks, a service is divided into ``pre-'', ``intra-'', and
``post-'' service components. The preservice component consists of all
services furnished before the physician makes the skin incision (for
example, preoperative evaluation and scrubbing)
[[Page 31030]]
the intraservice component consists of the ``skin-to-skin'' time, and
the postservice component includes immediate postsurgery services and
subsequent hospital and office visits. Each component (or building
block) is then assigned work RVUs. Preservice and intraservice work
RVUs are based on time and intensity, and postservice work is based on
the specified evaluation and management service for each postoperative
visit. These three values are then summed to compute ``building-block''
work RVUs.
The results of the surveys were reviewed and organized by the
specialty society and then presented to the RUC. Based on the survey
results and a discussion, the RUC developed a recommendation. The RUC
used six workgroups to evaluate the codes. Each workgroup evaluated a
series of related codes and submitted its report to the full RUC. The
RUC then evaluated those reports and sent recommendations to us. Both
the workgroups and the RUC evaluated the relative work (time and
intensity) for each service compared to other services on the fee
schedule.
We received recommendations on work RVUs from the RUC for all of
the codes we forwarded, with the exception of the anesthesia codes and
conscious sedation codes.
II. Discussion of Comments and Decisions
A. Review of Comments
During the comment period for our November 2, 1999 final rule, we
received approximately 35 public comments on approximately 900 codes.
After review by our medical staff, we forwarded all of the comments we
received concerning misvalued services to the RUC. The RUC submitted
work RVU recommendations for all of the codes we forwarded with the
exception of the anesthesia codes and conscious sedation codes. The RUC
used six workgroups to evaluate the codes. Each workgroup evaluated a
series of related codes and submitted its report to the full RUC. The
RUC then evaluated those reports and sent its recommendations to us.
Both the workgroups and the RUC evaluated the relative work (time and
intensity) for each service compared to other services on the fee
schedule.
As discussed below, we further analyzed all of the RUC
recommendations; we evaluated both the recommended work RVUs and the
rationale for the recommendations. If we had concerns about the
application of a particular methodology, we verified that the
recommended work RVUs were appropriate by using alternative
methodologies.
Table 1, Five-Year Review of Work Relative Value Units, lists the
codes reviewed during the 5-year review. This table includes the
following information:
CPT/HCPCS Code. This is the CPT or alphanumeric HCPCS code
for a service.
Modifier. A modifier-26 is shown if the work RVUs
represent the professional component of the service.
Description. This is an abbreviated version of the
narrative description of the code.
2000 Work RVUs. The work RVUs that appeared in the
November 2, 1999 final rule are shown for each reviewed code.
Requested Work RVUs. This column identifies the work RVUs
requested by the commenting specialty or individual commenter. If we
received more than one comment on a code, the code is listed more than
once with the recommended RVUs. If the commenters did not recommend
specific RVUs, we indicate this by ``N/A''. A ``WD'' (withdrawal)
indicates the commenter withdrew the request for review of a code and
chose not to pursue review of the code under the 5-year review.
RUC Recommendation. This column identifies the work RVUs
recommended by the RUC. ``CPT'' indicates that that the RUC referred
this code to the AMA CPT Editorial Panel for review and clarification
and recommended maintaining the current work RVUs. An ``(e)'' indicates
the commenting specialty withdrew the proposal; therefore, the RUC
recommends maintaining the current work RVUs.
HCPAC Recommendation. This column identifies the work RVUs
recommended by the HCPAC. An ``(a)'' in this column indicates there was
no HCPAC recommendation.
HCFA Decision. This column indicates whether we agreed
with the RUC recommendation (``agree''); we are proposing work RVUs
higher than the RUC recommendation (``increase''); or we are proposing
work RVUs that are less than the RUC recommendation (``decrease'').
Codes for which we did not accept the RUC recommendation are discussed
in greater detail following Table 1. An ``(a)'' in this column
indicates that in the absence of a RUC recommendation we are proposing
to maintain the present work RVUs. A ``(b)'' in this column indicates
that these services were reviewed as part of the July 2000
Multispecialty Refinement Panels for new and/or revised services.
(Meetings of Multispecialty Refinement Panels are conducted as needed
to allow specialty representatives the opportunity to discuss the
comments they submitted on our decisions on new or revised services
published in the final rule. The goal of multispecialty refinement
panels is to consider the interests of those who commented on the work
RVUs against the redistributive effects that would occur in other
specialties. Following each discussion of a specific service, panel
members were instructed to individually rate the service under
discussion. We then used a statistical analysis of these ratings to
create final work RVUs for the services under discussion.) A ``(d)''
indicates there was no HCPAC recommendation. We propose maintaining
current work RVUs.
Proposed work RVUs: This column contains the 2002 proposed
work RVUs.
The following is a categorization of our proposals as related to
the RUC recommended work RVUs from the 5-year review of work RVUs. The
RUC supplied us with recommendations on 857 services. We accepted RUC's
recommended work RVUs for 792 of the services reviewed and disagreed
with RUC's recommended work RVUs for 65 of the services reviewed. This
is an acceptance percentage of 92 percent. Of the 65 services for which
we did not accept the RUC's recommended work RVUs we increased the work
RVUs for 37 services, decreased the work RVUs for 22 services, and
rejected the RUC recommendation of an increase for 6 services that had
already been reviewed at the Multispecialty Refinement Panel for CY
2000.
Additionally, the HCPAC reviewed a total of 12 services as part of
the 5-year review. For 5 of the services reviewed, the HCPAC did not
offer a recommendation. Of the remaining 7 services reviewed by the
HCPAC, we have accepted the HCPAC recommendations.
[[Page 31031]]
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\1\ All CPT codes and descriptors copyright 2000 American Medical
Association
[[Page 31031]]
Table 1.--Five-Year Review of Work Relative Value Units
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CPT/HCPCS 2000 work Requested HCFA Proposed
code \1\ Mod Descriptor RVU work RVU RUC REC HCPAC REC decision work RVU
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11055......... ....... Trim skin 0.27 0.43 .......... (a) (a) 0.27
lesion.
11056......... ....... Trim skin 0.39 0.61 .......... (a) (a) 0.39
lesion, 2 to 4.
11057......... ....... Trim skin 0.50 0.79 .......... (a) (a) 0.50
lesions, over
4.
11100......... ....... Biopsy of skin 0.81 WD (e) .......... (a) 0.81
lesion.
11402......... ....... Removal of skin 1.61 2.20 1.61 .......... agree 1.61
lesion.
11642......... ....... Removal of skin 2.93 3.05 2.93 .......... agree 2.93
lesion.
11642......... ....... Removal of skin 2.93 3.87 2.93 .......... agree 2.93
lesion.
11719......... ....... Trim nail(s)... 0.11 0.17 .......... (a) (a) 0.11
11730......... ....... Removal of nail 1.13 WD (e) .......... (a) 1.13
plate.
12001......... ....... Repair 1.70 N/A CPT .......... CPT 1.70
superficial
wound(s).
12002......... ....... Repair 1.86 N/A CPT .......... CPT 1.86
superficial
wound(s).
12011......... ....... Repair 1.76 2.37 1.76 .......... agree 1.76
superficial
wound(s).
13101......... ....... Repair of wound 3.92 5.43 3.92 .......... agree 3.92
or lesion.
13131......... ....... Repair of wound 3.79 4.79 3.79 .......... agree 3.79
or lesion.
13132......... ....... Repair of wound 5.95 6.95 5.95 .......... agree 5.95
or lesion.
15000......... ....... Skin graft..... 4.00 5.95 CPT .......... CPT 4.00
15001......... ....... Skin graft add- 1.00 2.50 CPT .......... CPT 1.00
on.
15100......... ....... Skin split 9.05 9.05 CPT .......... CPT 9.05
graft.
15101......... ....... Skin split 1.72 1.72 CPT .......... CPT 1.72
graft add-on.
15120......... ....... Skin split 9.83 9.83 CPT .......... CPT 9.83
graft.
15121......... ....... Skin split 2.67 2.67 CPT .......... CPT 2.67
graft add-on.
15350......... ....... Skin homograft. 4.00 4.00 CPT .......... CPT 4.00
15351......... ....... Skin homograft 1.00 1.00 CPT .......... CPT 1.00
add-on.
15400......... ....... Skin 4.00 4.00 CPT .......... CPT 4.00
heterograft.
15401......... ....... Skin 1.00 1.00 CPT .......... CPT 1.00
heterograft
add-on.
17000......... ....... Destroy benign/ 0.60 WD (e) .......... (a) 0.60
premal lesion.
17003......... ....... Destroy 0.15 WD (e) .......... (a) 0.15
lesions, 2-14.
17004......... ....... Destroy 2.79 WD (e) .......... (a) 2.79
lesions, 15 or
more.
19000......... ....... Drainage of 0.84 1.27 0.84 .......... agree 0.84
breast lesion.
19100......... ....... Biopsy of 1.27 3.88 1.27 .......... agree 1.27
breast.
19125......... ....... Excision, 6.06 9.00 6.06 .......... agree 6.06
breast lesion.
19160......... ....... Removal of 5.99 8.38 5.99 .......... agree 5.99
breast tissue.
19162......... ....... Remove breast 13.53 15.68 13.53 .......... agree 13.53
tissue, nodes.
19240......... ....... Removal of 16.00 18.87 16.00 .......... agree 16.00
breast.
20205......... ....... Deep muscle 2.35 3.42 CPT .......... CPT 2.35
biopsy.
20245......... ....... Bone biopsy, 3.95 7.97 8.50 .......... decrease 7.78
excisional.
20600......... ....... Drain/inject, 0.66 WD (e) .......... (a) 0.66
joint/bursa.
20605......... ....... Drain/inject, 0.68 WD (e) .......... (a) 0.68
joint/bursa.
21740......... ....... Reconstruction 16.50 21.00 CPT .......... CPT 16.50
of sternum.
21800......... ....... Treatment of 0.96 1.77 0.96 .......... agree 0.96
rib fracture.
23076......... ....... Removal of 7.63 13.40 CPT .......... CPT 7.63
shoulder
lesion.
23472......... ....... Reconstruct 16.92 21.27 21.10 .......... agree 21.10
shoulder joint.
23485......... ....... Revision of 13.43 18.73 13.43 .......... agree 13.43
collar bone.
23585......... ....... Treat scapula 8.96 11.46 8.96 .......... agree 8.96
fracture.
23615......... ....... Treat humerus 9.35 15.85 9.35 .......... agree 9.35
fracture.
23630......... ....... Treat humerus 7.35 12.45 7.35 .......... agree 7.35
fracture.
23680......... ....... Treat 10.06 13.10 10.06 .......... agree 10.06
dislocation/
fracture.
24076......... ....... Remove arm/ 6.30 10.20 CPT .......... CPT 6.30
elbow lesion.
24435......... ....... Repair humerus 13.17 20.36 13.17 .......... agree 13.17
with graft.
24545......... ....... Treat humerus 10.46 12.26 10.46 .......... agree 10.46
fracture.
25076......... ....... Removal of 4.92 12.96 CPT .......... CPT 4.92
forearm lesion.
26562......... ....... Repair of web 9.68 12.56 15.00 .......... agree 15.00
finger.
27048......... ....... Remove hip/ 6.25 13.01 CPT .......... CPT 6.25
pelvis lesion.
27075......... ....... Extensive hip 17.23 28.52 35.00 .......... agree 35.00
surgery.
27077......... ....... Extensive hip 23.13 30.00 40.00 .......... agree 40.00
surgery.
27216......... ....... Treat pelvic 15.19 25.00 15.19 .......... agree 15.19
ring fracture.
27217......... ....... Treat pelvic 14.11 17.11 14.11 .......... agree 14.11
ring fracture.
27218......... ....... Treat pelvic 20.15 22.15 20.15 .......... agree 20.15
ring fracture.
27226......... ....... Treat hip wall 14.91 19.91 14.91 .......... agree 14.91
fracture.
27236......... ....... Treat thigh 15.60 17.60 15.60 .......... agree 15.60
fracture.
27280......... ....... Fusion of 13.39 21.00 13.39 .......... agree 13.39
sacroiliac
joint.
27282......... ....... Fusion of pubic 11.34 21.66 11.34 .......... agree 11.34
bones.
27284......... ....... Fusion of hip 16.76 20.12 23.45 .......... agree 23.45
joint.
27328......... ....... Removal of 5.57 8.70 CPT .......... CPT 5.57
thigh lesion.
[[Page 31032]]
27472......... ....... Repair/graft of 17.72 23.62 17.72 .......... agree 17.72
thigh.
27513......... ....... Treatment of 17.92 20.92 17.92 .......... agree 17.92
thigh fracture.
27536......... ....... Treat knee 15.65 19.00 15.65 .......... agree 15.65
fracture.
27590......... ....... Amputate leg at 12.03 15.52 12.03 .......... agree 12.03
thigh.
27619......... ....... Remove lower 8.40 10.02 CPT .......... CPT 8.40
leg lesion.
27724......... ....... Repair/graft of 14.99 19.34 18.20 .......... agree 18.20
tibia.
27822......... ....... Treatment of 9.20 10.68 11.00 .......... agree 11.00
ankle fracture.
27823......... ....... Treatment of 11.80 13.27 13.00 .......... agree 13.00
ankle fracture.
27828......... ....... Treat lower leg 16.23 19.00 16.23 .......... agree 16.23
fracture.
28299......... ....... Correction of 8.88 11.90 9.18 .......... agree 9.18
bunion.
28322......... ....... Repair of 8.34 13.26 8.34 .......... agree 8.34
metatarsals.
28420......... ....... Treat/graft 16.64 23.52 16.64 .......... agree 16.64
heel fracture.
28445......... ....... Treat ankle 9.33 15.97 15.62 .......... agree 15.62
fracture.
28705......... ....... Fusion of foot 15.21 20.46 18.80 .......... agree 18.80
bones.
29450......... ....... Application of 1.02 3.00 2.08 .......... agree 2.08
leg cast.
29450......... ....... Application of 1.02 N/A 2.08 .......... agree 2.08
leg cast.
29881......... ....... Knee 7.76 WD (e) .......... (a) 7.76
arthroscopy/
surgery.
29883......... ....... Knee 9.46 12.00 11.05 .......... agree 11.05
arthroscopy/
surgery.
29889......... ....... Knee 15.13 16.68 16.00 .......... agree 16.00
arthroscopy/
surgery.
29889......... ....... Knee 15.13 18.47 16.00 .......... agree 16.00
arthroscopy/
surgery.
31600......... ....... Incision of 3.62 6.42 7.18 .......... agree 7.18
windpipe.
31622......... ....... Dx bronchoscope/ 2.78 4.17 2.78 .......... agree 2.78
wash.
31622......... ....... Dx bronchoscope/ 2.78 N/A 2.78 .......... agree 2.78
wash.
31625......... ....... Bronchoscopy 3.37 N/A 3.37 .......... agree 3.37
with biopsy.
31645......... ....... Bronchoscopy, 3.16 N/A 3.16 .......... agree 3.16
clear airways.
32000......... ....... Drainage of 1.54 2.88 1.54 .......... agree 1.54
chest.
32000......... ....... Drainage of 1.54 N/A 1.54 .......... agree 1.54
chest.
32005......... ....... Treat lung 2.19 N/A 2.19 .......... agree 2.19
lining
chemically.
32020......... ....... Insertion of 3.98 N/A 3.98 .......... agree 3.98
chest tube.
32035......... ....... Exploration of 8.67 N/A 8.67 .......... agree 8.67
chest.
32095......... ....... Biopsy through 8.36 N/A 8.36 .......... agree 8.36
chest wall.
32100......... ....... Exploration/ 11.84 N/A 15.24 .......... agree 15.24
biopsy of
chest.
32110......... ....... Explore/repair 13.62 N/A 23.00 .......... agree 23.00
chest.
32220......... ....... Release of lung 19.27 N/A 24.00 .......... agree 24.00
32225......... ....... Partial release 13.96 N/A 13.96 .......... agree 13.96
of lung.
32320......... ....... Free/remove 20.54 N/A 24.00 .......... agree 24.00
chest lining.
32440......... ....... Removal of lung 21.02 35.08 25.00 .......... agree 25.00
32440......... ....... Removal of lung 21.02 N/A 25.00 .......... agree 25.00
32480......... ....... Partial removal 18.32 27.17 23.75 .......... agree 23.75
of lung.
32480......... ....... Partial removal 18.32 N/A 23.75 .......... agree 23.75
of lung.
32482......... ....... Bilobectomy.... 19.71 N/A 25.00 .......... agree 25.00
32491......... ....... Lung volume 21.25 N/A 21.25 .......... agree 21.25
reduction.
32500......... ....... Partial removal 14.30 N/A 22.00 .......... agree 22.00
of lung.
32520......... ....... Remove lung & 21.68 N/A 21.68 .......... agree 21.68
revise chest.
32602......... ....... Thoracoscopy, 5.96 N/A 5.96 .......... agree 5.96
diagnostic.
32651......... ....... Thoracoscopy, 12.91 N/A 12.91 .......... agree 12.91
surgical.
32652......... ....... Thoracoscopy, 18.66 N/A 18.66 .......... agree 18.66
surgical.
32655......... ....... Thoracoscopy, 13.10 N/A 13.10 .......... agree 13.10
surgical.
32657......... ....... Thoracoscopy, 13.65 N/A 13.65 .......... agree 13.65
surgical.
33207......... ....... Insertion of 8.04 WD (e) .......... (a) 8.04
heart
pacemaker.
33234......... ....... Removal of 7.82 N/A 7.82 .......... agree 7.82
pacemaker
system.
33235......... ....... Removal of 9.40 N/A 9.40 .......... agree 9.40
pacemaker
electrode.
33400......... ....... Repair of 25.34 N/A 28.50 .......... agree 28.50
aortic valve.
33405......... ....... Replacement of 30.61 N/A 35.00 .......... agree 35.00
aortic valve.
33406......... ....... Replacement of 32.30 N/A 37.50 .......... agree 37.50
aortic valve.
33410......... ....... Replacement of 32.46 N/A 32.46 .......... agree 32.46
aortic valve.
33411......... ....... Replacement of 32.47 N/A 36.25 .......... agree 36.25
aortic valve.
33412......... ....... Replacement of 34.79 N/A 42.00 .......... agree 42.00
aortic valve.
33413......... ....... Replacement of 35.24 N/A 43.50 .......... agree 43.50
aortic valve.
33415......... ....... Revision, 27.15 N/A 27.15 .......... agree 27.15
subvalvular
tissue.
33425......... ....... Repair of 27.00 N/A 27.00 .......... agree 27.00
mitral valve.
33426......... ....... Repair of 31.03 N/A 33.00 .......... agree 33.00
mitral valve.
33427......... ....... Repair of 33.72 N/A 40.00 .......... agree 40.00
mitral valve.
33430......... ....... Replacement of 31.43 N/A 33.50 .......... agree 33.50
mitral valve.
33468......... ....... Revision of 30.12 N/A 30.12 .......... agree 30.12
tricuspid
valve.
33475......... ....... Replacement, 28.41 N/A 33.00 .......... agree 33.00
pulmonary
valve.
[[Page 31033]]
33506......... ....... Repair artery, 26.71 N/A 35.50 .......... agree 35.50
translocation.
33510......... ....... CABG, vein, 25.12 N/A 29.00 .......... agree 29.00
single.
33511......... ....... CABG, vein, two 27.40 N/A 30.00 .......... agree 30.00
33512......... ....... CABG, vein, 29.67 N/A 31.80 .......... agree 31.80
three.
33513......... ....... CABG, vein, 31.95 N/A 32.00 .......... agree 32.00
four.
33514......... ....... CABG, vein, 35.00 N/A 32.75 .......... agree 32.75
five.
33516......... ....... Cabg, vein, six 37.40 N/A 35.00 .......... agree 35.00
or more.
33517......... ....... CABG, artery- 2.57 N/A 2.57 .......... agree 2.57
vein, single.
33518......... ....... CABG, artery- 4.85 N/A 4.85 .......... agree 4.85
vein, two.
33519......... ....... CABG, artery- 7.12 N/A 7.12 .......... agree 7.12
vein, three.
33521......... ....... CABG, artery- 9.40 N/A 9.40 .......... agree 9.40
vein, four.
33522......... ....... CABG, artery- 11.67 N/A 11.67 .......... agree 11.67
vein, five.
33523......... ....... Cabg, art-vein, 13.95 N/A 13.95 .......... agree 13.95
six or more.
33530......... ....... Coronary 5.86 N/A 5.86 .......... agree 5.86
artery, bypass/
reop.
33533......... ....... CABG, arterial, 25.83 N/A 30.00 .......... agree 30.00
single.
33534......... ....... CABG, arterial, 28.82 N/A 32.20 .......... agree 32.20
two.
33535......... ....... CABG, arterial, 31.81 N/A 34.50 .......... agree 34.50
three.
33536......... ....... Cabg, arterial, 34.79 N/A 37.50 .......... agree 37.50
four or more.
33611......... ....... Repair double 32.30 N/A 34.00 .......... agree 34.00
ventricle.
33612......... ....... Repair double 33.26 N/A 35.00 .......... agree 35.00
ventricle.
33615......... ....... Repair, simple 32.06 N/A 34.00 .......... agree 34.00
fontan.
33617......... ....... Repair, 34.03 N/A 37.00 .......... agree 37.00
modified
fontan.
33619......... ....... Repair single 37.57 N/A 45.00 .......... agree 45.00
ventricle.
33641......... ....... Repair heart 21.39 N/A 21.39 .......... agree 21.39
septum defect.
33660......... ....... Repair of heart 25.54 N/A 30.00 .......... agree 30.00
defects.
33670......... ....... Repair of heart 32.73 N/A 35.00 .......... agree 35.00
chambers.
33681......... ....... Repair heart 27.67 N/A 30.61 .......... agree 30.61
septum defect.
33694......... ....... Repair of heart 31.73 N/A 34.00 .......... agree 34.00
defects.
33697......... ....... Repair of heart 33.71 N/A 36.00 .......... agree 36.00
defects.
33730......... ....... Repair heart- 31.67 N/A 34.25 .......... agree 34.25
vein defect(s).
33750......... ....... Major vessel 21.41 N/A 21.41 .......... agree 21.41
shunt.
33767......... ....... Major vessel 24.50 N/A 24.50 .......... agree 24.50
shunt.
33770......... ....... Repair great 33.29 N/A 37.00 .......... agree 37.00
vessels defect.
33778......... ....... Repair great 35.82 N/A 40.00 .......... agree 40.00
vessels defect.
33780......... ....... Repair great 36.94 N/A 41.75 .......... agree 41.75
vessels defect.
33786......... ....... Repair arterial 34.84 N/A 39.00 .......... agree 39.00
trunk.
33820......... ....... Revise major 16.29 N/A 16.29 .......... agree 16.29
vessel.
33840......... ....... Remove aorta 20.63 N/A 20.63 .......... agree 20.63
constriction.
33860......... ....... Ascending 33.96 N/A 38.00 .......... agree 38.00
aortic graft.
33861......... ....... Ascending 34.52 N/A 42.00 .......... agree 42.00
aortic graft.
33863......... ....... Ascending 36.47 N/A 45.00 .......... agree 45.00
aortic graft.
33870......... ....... Transverse 40.31 N/A 44.00 .......... agree 44.00
aortic arch
graft.
33875......... ....... Thoracic aortic 33.06 N/A CPT .......... CPT 33.06
graft.
33877......... ....... Thoracoabdomina 42.60 N/A CPT .......... CPT 42.60
l graft.
33917......... ....... Repair 24.50 N/A 24.50 .......... agree 24.50
pulmonary
artery.
33919......... ....... Repair 32.67 N/A 40.00 .......... agree 40.00
pulmonary
atresia.
33945......... ....... Transplantation 42.10 N/A 42.10 .......... agree 42.10
of heart.
34001......... ....... Removal of 12.91 WD (e) .......... (a) 12.91
artery clot.
34101......... ....... Removal of 9.97 N/A 10.00 .......... agree 10.00
artery clot.
34111......... ....... Removal of arm 8.07 N/A 10.00 .......... agree 10.00
artery clot.
34151......... ....... Removal of 16.86 27.51 25.00 .......... agree 25.00
artery clot.
34151......... ....... Removal of 16.86 28.00 25.00 .......... agree 25.00
artery clot.
34201......... ....... Removal of 9.13 10.40 10.03 .......... agree 10.03
artery clot.
34201......... ....... Removal of 9.13 10.58 10.03 .......... agree 10.03
artery clot.
34203......... ....... Removal of leg 12.21 14.99 16.50 .......... agree 16.50
artery clot.
34203......... ....... Removal of leg 12.21 16.50 16.50 .......... agree 16.50
artery clot.
34401......... ....... Removal of vein 12.86 26.63 25.00 .......... agree 25.00
clot.
34401......... ....... Removal of vein 12.86 28.00 25.00 .......... agree 25.00
clot.
34421......... ....... Removal of vein 9.93 15.75 12.00 .......... agree 12.00
clot.
34421......... ....... Removal of vein 9.93 15.94 12.00 .......... agree 12.00
clot.
34451......... ....... Removal of vein 14.44 29.05 27.00 .......... agree 27.00
clot.
34451......... ....... Removal of vein 14.44 30.00 27.00 .......... agree 27.00
clot.
34490......... ....... Removal of vein 7.60 N/A 9.86 .......... agree 9.86
clot.
34501......... ....... Repair valve, 10.93 N/A 16.00 .......... agree 16.00
femoral vein.
34510......... ....... Transposition 13.25 N/A 18.95 .......... agree 18.95
of vein valve.
34520......... ....... Cross-over vein 13.74 N/A 17.95 .......... agree 17.95
graft.
[[Page 31034]]
34530......... ....... Leg vein fusion 17.61 N/A 16.64 .......... agree 16.64
35011......... ....... Repair defect 11.65 14.10 18.00 .......... agree 18.00
of artery.
35011......... ....... Repair defect 11.65 18.00 18.00 .......... agree 18.00
of artery.
35013......... ....... Repair artery 17.40 15.38 22.00 .......... agree 22.00
rupture, arm.
35013......... ....... Repair artery 17.40 20.00 22.00 .......... agree 22.00
rupture, arm.
35045......... ....... Repair defect 11.26 11.05 17.57 .......... agree 17.57
of arm artery.
35045......... ....... Repair defect 11.26 16.50 17.57 .......... agree 17.57
of arm artery.
35081......... ....... Repair defect 28.01 33.13 28.01 .......... agree 28.01
of artery.
35082......... ....... Repair artery 36.35 37.00 38.50 .......... agree 38.50
rupture, aorta.
35082......... ....... Repair artery 36.35 41.80 38.50 .......... agree 38.50
rupture, aorta.
35092......... ....... Repair artery 38.39 50.00 45.00 .......... agree 45.00
rupture, aorta.
35092......... ....... Repair artery 38.39 58.61 45.00 .......... agree 45.00
rupture, aorta.
35103......... ....... Repair artery 33.57 41.00 40.50 .......... agree 40.50
rupture, groin.
35103......... ....... Repair artery 33.57 44.12 40.50 .......... agree 40.50
rupture, groin.
35111......... ....... Repair defect 16.43 23.24 25.00 .......... agree 25.00
of artery.
35111......... ....... Repair defect 16.43 28.00 25.00 .......... agree 25.00
of artery.
35112......... ....... Repair artery 18.69 29.20 30.00 .......... agree 30.00
rupture,spleen.
35112......... ....... Repair artery 18.69 30.00 30.00 .......... agree 30.00
rupture,spleen.
35121......... ....... Repair defect 25.99 30.29 30.00 .......... agree 30.00
of artery.
35121......... ....... Repair defect 25.99 32.00 30.00 .......... agree 30.00
of artery.
35122......... ....... Repair artery 33.45 36.83 35.00 .......... agree 35.00
rupture, belly.
35122......... ....... Repair artery 33.45 37.00 35.00 .......... agree 35.00
rupture, belly.
35131......... ....... Repair defect 18.55 23.15 25.00 .......... agree 25.00
of artery.
35131......... ....... Repair defect 18.55 28.00 25.00 .......... agree 25.00
of artery.
35132......... ....... Repair artery 21.95 30.00 30.00 .......... agree 30.00
rupture, groin.
35132......... ....... Repair artery 21.95 30.54 30.00 .......... agree 30.00
rupture, groin.
35141......... ....... Repair defect 14.46 19.38 20.00 .......... agree 20.00
of artery.
35141......... ....... Repair defect 14.46 20.00 20.00 .......... agree 20.00
of artery.
35142......... ....... Repair artery 15.86 23.36 23.30 .......... agree 23.30
rupture, thigh.
35142......... ....... Repair artery 15.86 25.00 23.30 .......... agree 23.30
rupture, thigh.
35151......... ....... Repair defect 17.00 20.26 22.64 .......... agree 22.64
of artery.
35151......... ....... Repair defect 17.00 22.00 22.64 .......... agree 22.64
of artery.
35152......... ....... Repair artery 16.70 24.98 25.62 .......... agree 25.62
rupture, knee.
35152......... ....... Repair artery 16.70 27.50 25.62 .......... agree 25.62
rupture, knee.
35182......... ....... Repair blood 17.74 N/A 30.00 .......... agree 30.00
vessel lesion.
35184......... ....... Repair blood 12.25 N/A 18.00 .......... agree 18.00
vessel lesion.
35189......... ....... Repair blood 18.43 N/A 28.00 .......... agree 28.00
vessel lesion.
35190......... ....... Repair blood 12.75 N/A 12.75 .......... agree 12.75
vessel lesion.
35201......... ....... Repair blood 9.99 12.74 16.14 .......... agree 16.14
vessel lesion.
35201......... ....... Repair blood 9.99 18.35 16.14 .......... agree 16.14
vessel lesion.
35206......... ....... Repair blood 9.25 N/A 13.25 .......... agree 13.25
vessel lesion.
35221......... ....... Repair blood 16.42 26.00 24.39 .......... agree 24.39
vessel lesion.
35221......... ....... Repair blood 16.42 28.95 24.39 .......... agree 24.39
vessel lesion.
35226......... ....... Repair blood 9.06 14.00 14.50 .......... agree 14.50
vessel lesion.
35226......... ....... Repair blood 9.06 15.82 14.50 .......... agree 14.50
vessel lesion.
35231......... ....... Repair blood 12.00 15.64 20.00 .......... agree 20.00
vessel lesion.
35231......... ....... Repair blood 12.00 18.90 20.00 .......... agree 20.00
vessel lesion.
35236......... ....... Repair blood 10.54 12.85 17.11 .......... agree 17.11
vessel lesion.
35236......... ....... Repair blood 10.54 18.00 17.11 .......... agree 17.11
vessel lesion.
35246......... ....... Repair blood 19.84 26.00 26.45 .......... agree 26.45
vessel lesion.
35246......... ....... Repair blood 19.84 N/A 26.45 .......... agree 26.45
vessel lesion.
35251......... ....... Repair blood 17.49 31.00 30.20 .......... agree 30.20
vessel lesion.
35251......... ....... Repair blood 17.49 34.04 30.20 .......... agree 30.20
vessel lesion.
35256......... ....... Repair blood 11.38 N/A 18.36 .......... agree 18.36
vessel lesion.
35261......... ....... Repair blood 11.63 15.51 17.80 .......... agree 17.80
vessel lesion.
35261......... ....... Repair blood 11.63 18.90 17.80 .......... agree 17.80
vessel lesion.
35266......... ....... Repair blood 10.30 15.79 14.91 .......... agree 14.91
vessel lesion.
35266......... ....... Repair blood 10.30 17.00 14.91 .......... agree 14.91
vessel lesion.
35276......... ....... Repair blood 18.75 22.00 24.25 .......... agree 24.25
vessel lesion.
35276......... ....... Repair blood 18.75 N/A 24.25 .......... agree 24.25
vessel lesion.
35281......... ....... Repair blood 16.48 29.00 28.00 .......... agree 28.00
vessel lesion.
35281......... ....... Repair blood 16.48 32.01 28.00 .......... agree 28.00
vessel lesion.
35286......... ....... Repair blood 11.87 N/A 16.16 .......... agree 16.16
vessel lesion.
35311......... ....... Rechanneling of 23.85 30.00 27.00 .......... agree 27.00
artery.
35311......... ....... Rechanneling of 23.85 N/A 27.00 .......... agree 27.00
artery.
35321......... ....... Rechanneling of 11.97 16.47 16.00 .......... agree 16.00
artery.
[[Page 31035]]
35321......... ....... Rechanneling of 11.97 18.35 16.00 .......... agree 16.00
artery.
35331......... ....... Rechanneling of 23.52 24.81 26.20 .......... agree 26.20
artery.
35331......... ....... Rechanneling of 23.52 28.01 26.20 .......... agree 26.20
artery.
35351......... ....... Rechanneling of 20.11 24.09 23.00 .......... agree 23.00
artery.
35351......... ....... Rechanneling of 20.11 25.50 23.00 .......... agree 23.00
artery.
35355......... ....... Rechanneling of 16.09 20.01 18.50 .......... agree 18.50
artery.
35355......... ....... Rechanneling of 16.09 20.75 18.50 .......... agree 18.50
artery.
35361......... ....... Rechanneling of 23.59 29.08 28.20 .......... agree 28.20
artery.
35361......... ....... Rechanneling of 23.59 30.00 28.20 .......... agree 28.20
artery.
35363......... ....... Rechanneling of 24.66 32.00 30.20 .......... agree 30.20
artery.
35363......... ....... Rechanneling of 24.66 35.67 30.20 .......... agree 30.20
artery.
35371......... ....... Rechanneling of 11.64 12.97 14.72 .......... agree 14.72
artery.
35371......... ....... Rechanneling of 11.64 17.75 14.72 .......... agree 14.72
artery.
35372......... ....... Rechanneling of 13.56 18.04 18.00 .......... agree 18.00
artery.
35372......... ....... Rechanneling of 13.56 19.53 18.00 .......... agree 18.00
artery.
35381......... ....... Rechanneling of 15.81 N/A CPT .......... CPT 15.81
artery.
35511......... ....... Artery bypass 16.83 19.75 21.20 .......... agree 21.20
graft.
35511......... ....... Artery bypass 16.83 21.50 21.20 .......... agree 21.20
graft.
35518......... ....... Artery bypass 15.42 18.59 21.20 .......... agree 21.20
graft.
35518......... ....... Artery bypass 15.42 23.00 21.20 .......... agree 21.20
graft.
35521......... ....... Artery bypass 16.17 20.46 22.20 .......... agree 22.20
graft.
35521......... ....... Artery bypass 16.17 25.25 22.20 .......... agree 22.20
graft.
35526......... ....... Artery bypass 20.00 30.00 29.95 .......... agree 29.95
graft.
35526......... ....... Artery bypass 20.00 N/A 29.95 .......... agree 29.95
graft.
35531......... ....... Artery bypass 25.61 33.62 36.20 .......... agree 36.20
graft.
35531......... ....... Artery bypass 25.61 38.00 36.20 .......... agree 36.20
graft.
35533......... ....... Artery bypass 20.52 28.00 28.00 .......... agree 28.00
graft.
35533......... ....... Artery bypass 20.52 29.99 28.00 .......... agree 28.00
graft.
35536......... ....... Artery bypass 23.11 25.33 31.70 .......... agree 31.70
graft.
35536......... ....... Artery bypass 23.11 33.00 31.70 .......... agree 31.70
graft.
35541......... ....... Artery bypass 25.80 N/A CPT .......... CPT 25.80
graft.
35546......... ....... Artery bypass 25.54 N/A CPT .......... CPT 25.54
graft.
35551......... ....... Artery bypass 26.67 N/A CPT .......... CPT 26.67
graft.
35556......... ....... Artery bypass 21.76 24.50 21.76 .......... agree 21.76
graft.
35556......... ....... Artery bypass 21.76 24.50 21.76 .......... agree 21.76
graft.
35558......... ....... Artery bypass 14.04 22.00 21.20 .......... agree 21.20
graft.
35558......... ....... Artery bypass 14.04 22.08 21.20 .......... agree 21.20
graft.
35560......... ....... Artery bypass 23.56 28.19 32.00 .......... agree 32.00
graft.
35560......... ....... Artery bypass 23.56 35.50 32.00 .......... agree 32.00
graft.
35563......... ....... Artery bypass 15.14 24.00 24.20 .......... agree 24.20
graft.
35563......... ....... Artery bypass 15.14 25.00 24.20 .......... agree 24.20
graft.
35565......... ....... Artery bypass 15.14 23.65 23.20 .......... agree 23.20
graft.
35565......... ....... Artery bypass 15.14 24.00 23.20 .......... agree 23.20
graft.
35571......... ....... Artery bypass 18.58 23.65 24.06 .......... agree 24.06
graft.
35571......... ....... Artery bypass 18.58 26.92 24.06 .......... agree 24.06
graft.
35582......... ....... Vein bypass 27.13 N/A CPT .......... CPT 27.13
graft.
35587......... ....... Vein bypass 19.05 24.47 24.75 .......... agree 24.75
graft.
35587......... ....... Vein bypass 19.05 27.00 24.75 .......... agree 24.75
graft.
35621......... ....... Artery bypass 14.54 16.53 20.00 .......... agree 20.00
graft.
35621......... ....... Artery bypass 14.54 21.50 20.00 .......... agree 20.00
graft.
35623......... ....... Bypass graft, 16.62 17.62 24.00 .......... agree 24.00
not vein.
35623......... ....... Bypass graft, 16.62 25.75 24.00 .......... agree 24.00
not vein.
35626......... ....... Artery bypass 23.63 27.58 27.75 .......... agree 27.75
graft.
35626......... ....... Artery bypass 23.63 30.00 27.75 .......... agree 27.75
graft.
35631......... ....... Artery bypass 24.60 32.51 34.00 .......... agree 34.00
graft.
35631......... ....... Artery bypass 24.60 36.00 34.00 .......... agree 34.00
graft.
35636......... ....... Artery bypass 22.46 27.32 29.50 .......... agree 29.50
graft.
35636......... ....... Artery bypass 22.46 36.00 29.50 .......... agree 29.50
graft.
35641......... ....... Artery bypass 24.57 N/A CPT .......... CPT 24.57
graft.
35646......... ....... Artery bypass 25.81 N/A CPT .......... CPT 25.81
graft.
35650......... ....... Artery bypass 14.36 15.74 19.00 .......... agree 19.00
graft.
35650......... ....... Artery bypass 14.36 19.80 19.00 .......... agree 19.00
graft.
35654......... ....... Artery bypass 18.61 23.54 25.00 .......... agree 25.00
graft.
35654......... ....... Artery bypass 18.61 26.00 25.00 .......... agree 25.00
graft.
35661......... ....... Artery bypass 13.18 17.89 19.00 .......... agree 19.00
graft.
35661......... ....... Artery bypass 13.18 19.53 19.00 .......... agree 19.00
graft.
[[Page 31036]]
35663......... ....... Artery bypass 14.17 20.90 22.00 .......... agree 22.00
graft.
35663......... ....... Artery bypass 14.17 23.00 22.00 .......... agree 22.00
graft.
35665......... ....... Artery bypass 15.40 19.84 21.00 .......... agree 21.00
graft.
35665......... ....... Artery bypass 15.40 22.00 21.00 .......... agree 21.00
graft.
35666......... ....... Artery bypass 19.19 20.00 22.19 .......... agree 22.19
graft.
35666......... ....... Artery bypass 19.19 22.00 22.19 .......... agree 22.19
graft.
35671......... ....... Artery bypass 14.80 17.80 19.33 .......... agree 19.33
graft.
35671......... ....... Artery bypass 14.80 24.00 19.33 .......... agree 19.33
graft.
35701......... ....... Exploration, 5.55 9.38 8.50 .......... agree 8.50
carotid artery.
35701......... ....... Exploration, 5.55 15.00 8.50 .......... agree 8.50
carotid artery.
35721......... ....... Exploration, 5.28 N/A 7.18 .......... agree 7.18
femoral artery.
35741......... ....... Exploration 5.37 N/A 8.00 .......... agree 8.00
popliteal
artery.
35840......... ....... Explore 9.77 N/A CPT .......... CPT 9.77
abdominal
vessels.
35860......... ....... Explore limb 5.55 N/A CPT .......... CPT 5.55
vessels.
35905......... ....... Excision, 18.19 32.00 31.25 .......... agree 31.25
graft, thorax.
35905......... ....... Excision, 18.19 N/A 31.25 .......... agree 31.25
graft, thorax.
35907......... ....... Excision, 19.24 37.33 35.00 .......... agree 35.00
graft, abdomen.
35907......... ....... Excision, 19.24 40.00 35.00 .......... agree 35.00
graft, abdomen.
36400......... ....... Drawing blood.. 0.18 N/A 0.38 .......... decrease 0.18
36405......... ....... Drawing blood.. 0.18 N/A 0.32 .......... decrease 0.18
36406......... ....... Drawing blood.. 0.18 N/A CPT .......... CPT 0.18
36489......... ....... Insertion of 1.22 2.75 2.50 .......... agree 2.50
catheter, vein.
36489......... ....... Insertion of 1.22 3.41 2.50 .......... agree 2.50
catheter, vein.
36520......... ....... Plasma and/or 1.74 N/A CPT .......... CPT 1.74
cell exchange.
36533......... ....... Insertion of 5.32 5.28 CPT .......... CPT 5.32
access device.
36534......... ....... Revision of 2.80 5.15 CPT .......... CPT 2.80
access device.
36535......... ....... Removal of 2.27 3.89 CPT .......... CPT 2.27
access device.
36600......... ....... Withdrawal of 0.32 WD (e) .......... (a) 0.32
arterial blood.
36620......... ....... Insertion 1.15 2.25 CPT .......... CPT 1.15
catheter,
artery.
36625......... ....... Insertion 2.11 2.65 2.11 .......... agree 2.11
catheter,
artery.
36822......... ....... Insertion of 5.42 19.00 5.42 .......... agree 5.42
cannula(s).
37565......... ....... Ligation of 4.44 9.01 10.88 .......... agree 10.88
neck vein.
37565......... ....... Ligation of 4.44 14.50 10.88 .......... agree 10.88
neck vein.
37600......... ....... Ligation of 4.57 9.19 11.25 .......... agree 11.25
neck artery.
37600......... ....... Ligation of 4.57 14.00 11.25 .......... agree 11.25
neck artery.
37605......... ....... Ligation of 6.19 11.85 13.11 .......... agree 13.11
neck artery.
37605......... ....... Ligation of 6.19 17.50 13.11 .......... agree 13.11
neck artery.
37609......... ....... Temporal artery 2.30 3.38 3.00 .......... agree 3.00
procedure.
37609......... ....... Temporal artery 2.30 N/A 3.00 .......... agree 3.00
procedure.
37615......... ....... Ligation of 5.73 12.31 CPT .......... CPT 5.73
neck artery.
37615......... ....... Ligation of 5.73 18.00 CPT .......... CPT 5.73
neck artery.
37617......... ....... Ligation of 15.95 N/A 22.06 .......... agree 22.06
abdomen artery.
37618......... ....... Ligation of 4.84 N/A CPT .......... CPT 4.84
extremity
artery.
37650......... ....... Revision of 5.13 N/A 7.80 .......... agree 7.80
major vein.
37660......... ....... Revision of 10.61 N/A 21.00 .......... agree 21.00
major vein.
37700......... ....... Revise leg vein 3.73 N/A CPT .......... CPT 3.73
37720......... ....... Removal of leg 5.66 10.71 CPT .......... CPT 5.66
vein.
37730......... ....... Removal of leg 7.33 N/A CPT .......... CPT 7.33
veins.
37735......... ....... Removal of leg 10.53 N/A CPT .......... CPT 10.53
veins/lesion.
37760......... ....... Revision of leg 10.47 N/A CPT .......... CPT 10.47
veins.
37785......... ....... Revision 3.84 N/A CPT .......... CPT 3.84
secondary
varicosity.
38100......... ....... Removal of 13.01 14.70 14.50 .......... agree 14.50
spleen, total.
38100......... ....... Removal of 13.01 16.21 14.50 .......... agree 14.50
spleen, total.
38101......... ....... Removal of 13.74 14.79 15.31 .......... agree 15.31
spleen,
partial.
38115......... ....... Repair of 14.19 15.55 15.82 .......... agree 15.82
ruptured
spleen.
38300......... ....... Drainage, lymph 1.53 1.01 1.99 .......... agree 1.99
node lesion.
38305......... ....... Drainage, lymph 4.61 6.59 6.00 .......... agree 6.00
node lesion.
38308......... ....... Incision of 4.95 7.35 6.45 .......... agree 6.45
lymph channels.
38500......... ....... Biopsy/removal, 2.88 3.29 3.75 .......... agree 3.75
lymph nodes.
38500......... ....... Biopsy/removal, 2.88 4.58 3.75 .......... agree 3.75
lymph nodes.
38510......... ....... Biopsy/removal, 4.14 6.28 6.43 .......... agree 6.43
lymph nodes.
38520......... ....... Biopsy/removal, 5.12 6.93 6.67 .......... agree 6.67
lymph nodes.
38525......... ....... Biopsy/removal, 4.66 5.30 6.07 .......... agree 6.07
lymph nodes.
38530......... ....... Biopsy/removal, 6.13 9.58 7.98 .......... agree 7.98
lymph nodes.
38571......... ....... Laparoscopy, 12.38 19.84 12.38 .......... agree 12.38
lymphadenectom
y.
38572......... ....... Laparoscopy, 14.32 23.17 16.59 .......... agree 16.59
lymphadenectom
y.
[[Page 31037]]
38740......... ....... Remove armpit 6.77 10.68 8.42 .......... increase 10.02
lymph nodes.
38745......... ....... Remove armpit 8.84 12.78 11.00 .......... increase 13.00
lymph nodes.
38746......... ....... Remove thoracic 4.39 N/A 4.89 .......... agree 4.89
lymph nodes.
38760......... ....... Remove groin 8.74 11.35 10.88 .......... increase 12.94
lymph nodes.
38765......... ....... Remove groin 16.06 18.77 19.98 .......... agree 19.98
lymph nodes.
38780......... ....... Remove abdomen 16.59 N/A 16.59 .......... agree 16.59
lymph nodes.
39010......... ....... Exploration of 11.79 N/A 11.79 .......... agree 11.79
chest.
39220......... ....... Removal chest 17.42 N/A 17.42 .......... agree 17.42
lesion.
39400......... ....... Visualization 5.61 N/A 5.61 .......... agree 5.61
of chest.
39503......... ....... Repair of 34.85 122.75 95.00 .......... decrease 34.85
diaphragm
hernia.
42205......... ....... Reconstruct 9.59 12.00 13.29 .......... agree 13.29
cleft palate.
43107......... ....... Removal of 28.79 N/A 40.00 .......... agree 40.00
esophagus.
43112......... ....... Removal of 31.22 N/A 43.50 .......... agree 43.50
esophagus.
43117......... ....... Partial removal 30.02 N/A 40.00 .......... agree 40.00
of esophagus.
43122......... ....... Parital removal 29.11 N/A 40.00 .......... agree 40.00
of esophagus.
43215......... ....... Esophagus 2.60 4.91 CPT .......... CPT 2.60
endoscopy.
43217......... ....... Esophagus 2.90 3.63 2.90 .......... agree 2.90
endoscopy.
43219......... ....... Esophagus 2.80 3.50 3.18 .......... decrease 2.80
endoscopy.
43228......... ....... Esoph 3.77 4.72 3.77 .......... agree 3.77
endoscopy,
ablation.
43239......... ....... Upper GI 2.69 2.96 2.87 .......... decrease 2.69
endoscopy,
biopsy.
43239......... ....... Upper GI 2.69 3.79 2.87 .......... decrease 2.69
endoscopy,
biopsy.
43244......... ....... Upper GI 4.59 5.05 5.05 .......... decrease 4.59
endoscopy/
ligation.
43246......... ....... Place 4.33 4.76 4.33 .......... agree 4.33
gastrostomy
tube.
43246......... ....... Place 4.33 5.04 4.33 .......... agree 4.33
gastrostomy
tube.
43247......... ....... Operative upper 3.39 4.51 3.59 .......... decrease 3.39
GI endoscopy.
43249......... ....... Esoph 2.90 5.01 3.35 .......... decrease 2.90
endoscopy,
dilation.
43251......... ....... Operative upper 3.70 4.44 3.70 .......... agree 3.70
GI endoscopy.
43255......... ....... Operative upper 4.40 5.40 4.82 .......... decrease 4.40
GI endoscopy.
43258......... ....... Operative upper 4.55 5.01 4.55 .......... agree 4.55
GI endoscopy.
43259......... ....... Endoscopic 4.89 N/A 8.59 .......... decrease 4.89
ultrasound
exam.
43263......... ....... Endo 6.19 7.12 7.29 .......... decrease 6.19
cholangiopancr
eatograph.
43265......... ....... Endo 8.90 N/A 10.02 .......... decrease 8.90
cholangiopancr
eatograph.
43269......... ....... Endo 6.04 7.50 8.21 .......... decrease 6.04
cholangiopancr
eatograph.
43305......... ....... Repair 17.15 WD (e) .......... (a) 17.15
esophagus and
fistula.
43310......... ....... Repair of 25.39 50.50 CPT .......... CPT 25.39
esophagus.
43312......... ....... Repair 28.42 56.75 CPT .......... CPT 28.42
esophagus and
fistula.
43320......... ....... Fuse esophagus 16.07 26.45 19.93 .......... agree 19.93
& stomach.
43324......... ....... Revise 16.58 17.75 20.57 .......... agree 20.57
esophagus &
stomach.
43325......... ....... Revise 16.17 21.65 20.06 .......... agree 20.06
esophagus &
stomach.
43326......... ....... Revise 15.91 20.53 19.74 .......... agree 19.74
esophagus &
stomach.
43330......... ....... Repair of 15.94 15.44 19.77 .......... agree 19.77
esophagus.
43331......... ....... Repair of 16.23 17.60 20.13 .......... agree 20.13
esophagus.
43340......... ....... Fuse esophagus 15.81 26.72 19.61 .......... agree 19.61
& intestine.
43341......... ....... Fuse esophagus 16.81 29.07 20.85 .......... agree 20.85
& intestine.
43350......... ....... Surgical 12.72 32.97 15.78 .......... agree 15.78
opening,
esophagus.
43351......... ....... Surgical 14.79 31.92 18.35 .......... agree 18.35
opening,
esophagus.
43352......... ....... Surgical 12.30 25.47 15.26 .......... agree 15.26
opening,
esophagus.
43360......... ....... Gastrointestina 28.78 61.17 35.70 .......... agree 35.70
l repair.
43361......... ....... Gastrointestina 32.65 65.83 40.50 .......... agree 40.50
l repair.
43400......... ....... Ligate 17.09 29.96 21.20 .......... agree 21.20
esophagus
veins.
43401......... ....... Esophagus 17.81 34.94 22.09 .......... agree 22.09
surgery for
veins.
43405......... ....... Ligate/staple 16.13 36.67 20.01 .......... agree 20.01
esophagus.
43410......... ....... Repair 10.86 13.65 13.47 .......... agree 13.47
esophagus
wound.
43415......... ....... Repair 17.06 30.45 25.00 .......... agree 25.00
esophagus
wound.
43420......... ....... Repair 11.57 14.10 14.35 .......... agree 14.35
esophagus
opening.
43425......... ....... Repair 16.95 26.93 21.03 .......... agree 21.03
esophagus
opening.
43500......... ....... Surgical 8.44 11.81 11.05 .......... agree 11.05
opening of
stomach.
43501......... ....... Surgical repair 15.31 20.44 20.04 .......... agree 20.04
of stomach.
43502......... ....... Surgical repair 17.67 21.20 23.13 .......... agree 23.13
of stomach.
43510......... ....... Surgical 9.99 18.81 13.08 .......... agree 13.08
opening of
stomach.
43520......... ....... Incision of 7.63 8.88 9.99 .......... agree 9.99
pyloric muscle.
43605......... ....... Biopsy of 9.15 10.41 11.98 .......... agree 11.98
stomach.
43610......... ....... Excision of 11.15 17.37 14.60 .......... agree 14.60
stomach lesion.
43611......... ....... Excision of 13.63 23.82 17.84 .......... agree 17.84
stomach lesion.
43620......... ....... Removal of 22.54 33.61 30.04 .......... agree 30.04
stomach.
43621......... ....... Removal of 23.06 35.55 30.73 .......... agree 30.73
stomach.
[[Page 31038]]
43622......... ....... Removal of 24.41 35.56 32.53 .......... agree 32.53
stomach.
43631......... ....... Removal of 19.66 23.28 22.59 .......... agree 22.59
stomach,
partial.
43632......... ....... Removal of 19.66 25.92 22.59 .......... agree 22.59
stomach,
partial.
43633......... ....... Removal of 20.10 27.68 23.10 .......... agree 23.10
stomach,
partial.
43634......... ....... Removal of 21.86 34.19 25.12 .......... agree 25.12
stomach,
partial.
43638......... ....... Removal of 21.76 29.96 29.00 .......... agree 29.00
stomach,
partial.
43638......... ....... Removal of 21.76 39.80 29.00 .......... agree 29.00
stomach,
partial.
43639......... ....... Removal of 22.25 39.80 29.65 .......... agree 29.65
stomach,
partial.
43640......... ....... Vagotomy & 14.81 17.32 17.02 .......... agree 17.02
pylorus repair.
43641......... ....... Vagotomy & 15.03 21.34 17.27 .......... agree 17.27
pylorus repair.
43651......... ....... Laparoscopy, 10.15 15.17 10.15 .......... agree 10.15
vagus nerve.
43652......... ....... Laparoscopy, 12.15 19.21 12.15 .......... agree 12.15
vagus nerve.
43800......... ....... Reconstruction 10.46 11.86 13.69 .......... agree 13.69
of pylorus.
43810......... ....... Fusion of 11.19 13.81 14.65 .......... agree 14.65
stomach and
bowel.
43820......... ....... Fusion of 11.74 15.78 15.37 .......... agree 15.37
stomach and
bowel.
43825......... ....... Fusion of 14.68 18.16 19.22 .......... agree 19.22
stomach and
bowel.
43830......... ....... Place 7.28 7.28 9.53 .......... agree 9.53
gastrostomy
tube.
43832......... ....... Place 11.92 11.92 15.60 .......... agree 15.60
gastrostomy
tube.
43840......... ....... Repair of 11.89 11.89 15.56 .......... agree 15.56
stomach lesion.
43842......... ....... Gastroplasty 14.71 17.14 18.47 .......... agree 18.47
for obesity.
43843......... ....... Gastroplasty 14.85 20.62 18.65 .......... agree 18.65
for obesity.
43846......... ....... Gastric bypass 19.15 23.43 24.05 .......... agree 24.05
for obesity.
43847......... ....... Gastric bypass 21.44 29.95 26.92 .......... agree 26.92
for obesity.
43848......... ....... Revision 23.41 27.07 29.39 .......... agree 29.39
gastroplasty.
43850......... ....... Revise stomach- 19.69 23.27 24.72 .......... agree 24.72
bowel fusion.
43855......... ....... Revise stomach- 20.83 24.15 26.16 .......... agree 26.16
bowel fusion.
43860......... ....... Revise stomach- 19.91 26.08 25.00 .......... agree 25.00
bowel fusion.
43865......... ....... Revise stomach- 21.12 27.30 26.52 .......... agree 26.52
bowel fusion.
43870......... ....... Repair stomach 7.40 9.65 9.69 .......... agree 9.69
opening.
43880......... ....... Repair stomach- 19.63 23.60 24.65 .......... agree 24.65
bowel fistula.
44005......... ....... Freeing of 13.84 15.43 16.23 .......... agree 16.23
bowel adhesion.
44010......... ....... Incision of 10.68 15.90 12.52 .......... agree 12.52
small bowel.
44020......... ....... Exploration of 11.93 15.04 13.99 .......... agree 13.99
small bowel.
44021......... ....... Decompress 12.01 15.18 14.08 .......... agree 14.08
small bowel.
44025......... ....... Incision of 12.18 14.08 14.28 .......... agree 14.28
large bowel.
44050......... ....... Reduce bowel 11.40 13.75 14.03 .......... agree 14.03
obstruction.
44050......... ....... Reduce bowel 11.40 14.58 14.03 .......... agree 14.03
obstruction.
44055......... ....... Correct 13.14 22.00 22.00 .......... agree 22.00
malrotation of
bowel.
44110......... ....... Excision of 10.07 14.39 11.81 .......... agree 11.81
bowel
lesion(s).
44111......... ....... Excision of 12.19 16.32 14.29 .......... agree 14.29
bowel
lesion(s).
44120......... ....... Removal of 14.50 15.82 17.00 .......... agree 17.00
small
intestine.
44125......... ....... Removal of 14.96 17.54 17.54 .......... agree 17.54
small
intestine.
44130......... ....... Bowel to bowel 12.36 17.87 14.49 .......... agree 14.49
fusion.
44130......... ....... Bowel to bowel 12.36 N/A 14.49 .......... agree 14.49
fusion.
44140......... ....... Partial removal 18.35 20.94 18.35 .......... increase 21.00
of colon.
44140......... ....... Partial removal 18.35 24.58 18.35 .......... increase 21.00
of colon.
44143......... ....... Partial removal 20.17 30.36 20.17 .......... increase 22.99
of colon.
44144......... ....... Partial removal 18.89 29.46 18.89 .......... increase 21.53
of colon.
44144......... ....... Partial removal 18.89 N/A 18.89 .......... increase 21.53
of colon.
44145......... ....... Partial removal 23.18 27.91 23.18 .......... increase 26.42
of colon.
44146......... ....... Partial removal 24.16 30.97 24.16 .......... increase 27.54
of colon.
44147......... ....... Partial removal 18.17 N/A 18.17 .......... increase 20.71
of colon.
44150......... ....... Removal of 21.01 27.41 21.01 .......... increase 23.95
colon.
44151......... ....... Removal of 20.04 32.89 20.04 .......... increase 26.88
colon/
ileostomy.
44151......... ....... Removal of 20.04 N/A 20.04 .......... increase 26.88
colon/
ileostomy.
44152......... ....... Removal of 24.41 33.61 24.41 .......... increase 27.83
colon/
ileostomy.
44153......... ....... Removal of 26.83 33.11 26.83 .......... increase 30.59
colon/
ileostomy.
44155......... ....... Removal of 24.44 33.61 24.44 .......... increase 27.86
colon/
ileostomy.
44156......... ....... Removal of 23.01 36.27 23.01 .......... increase 30.79
colon/
ileostomy.
44156......... ....... Removal of 23.01 N/A 23.01 .......... increase 30.79
colon/
ileostomy.
44160......... ....... Removal of 15.88 17.45 18.62 .......... agree 18.62
colon.
44200......... ....... Laparoscopy, 14.44 16.11 14.44 .......... agree 14.44
enterolysis.
44300......... ....... Open bowel to 8.88 13.09 12.11 .......... agree 12.11
skin.
44310......... ....... Ileostomy/ 11.70 18.14 15.95 .......... agree 15.95
jejunostomy.
44312......... ....... Revision of 5.88 6.79 8.02 .......... agree 8.02
ileostomy.
44314......... ....... Revision of 11.04 14.45 15.05 .......... agree 15.05
ileostomy.
[[Page 31039]]
44316......... ....... Devise bowel 15.47 26.57 21.09 .......... agree 21.09
pouch.
44320......... ....... Colostomy...... 12.94 18.84 17.64 .......... agree 17.64
44340......... ....... Revision of 5.66 6.79 7.72 .......... agree 7.72
colostomy.
44345......... ....... Revision of 11.32 14.45 15.43 .......... agree 15.43
colostomy.
44346......... ....... Revision of 12.46 17.19 16.99 .......... agree 16.99
colostomy.
44388......... ....... Colon endoscopy 2.82 3.10 3.70 .......... decrease 2.82
44389......... ....... Colonoscopy 3.13 3.44 4.26 .......... decrease 3.13
with biopsy.
44390......... ....... Colonoscopy for 3.83 4.21 4.81 .......... decrease 3.83
foreign body.
44391......... ....... Colonoscopy for 4.32 4.75 5.18 .......... decrease 4.32
bleeding.
44392......... ....... Colonoscopy and 3.82 4.20 4.81 .......... decrease 3.82
polypectomy.
44393......... ....... Colonoscopy, 4.84 5.32 5.00 .......... decrease 4.84
lesion removal.
44394......... ....... Colonoscopy w/ 4.43 4.87 4.43 .......... agree 4.43
snare.
44394......... ....... Colonoscopy w/ 4.43 N/A 4.43 .......... agree 4.43
snare.
44602......... ....... Suture, small 10.61 15.26 11.91 .......... increase 16.03
intestine.
44603......... ....... Suture, small 14.00 19.50 15.72 .......... increase 18.66
intestine.
44604......... ....... Suture, large 14.28 16.59 16.03 .......... agree 16.03
intestine.
44605......... ....... Repair of bowel 15.37 25.03 17.25 .......... increase 19.53
lesion.
44615......... ....... Intestinal 14.19 18.97 15.93 .......... agree 15.93
stricturoplast
y.
44620......... ....... Repair bowel 10.87 14.99 12.20 .......... agree 12.20
opening.
44625......... ....... Repair bowel 13.41 16.79 15.05 .......... agree 15.05
opening.
44626......... ....... Repair bowel 22.59 24.43 25.36 .......... agree 25.36
opening.
44640......... ....... Repair bowel- 14.83 22.29 16.65 .......... increase 21.65
skin fistula.
44650......... ....... Repair bowel 15.25 22.29 17.12 .......... increase 22.27
fistula.
44660......... ....... Repair bowel- 14.63 24.70 16.42 .......... increase 21.36
bladder
fistula.
44661......... ....... Repair bowel- 16.99 25.63 19.07 .......... increase 24.81
bladder
fistula.
44680......... ....... Surgical 13.72 21.32 15.40 .......... agree 15.40
revision,
intestine.
44700......... ....... Suspend bowel w/ 14.35 19.35 16.11 .......... agree 16.11
prosthesis.
44800......... ....... Excision of 11.23 10.85 11.23 .......... agree 11.23
bowel pouch.
44820......... ....... Excision of 10.31 11.23 12.09 .......... agree 12.09
mesentery
lesion.
44850......... ....... Repair of 9.57 12.00 10.74 .......... agree 10.74
mesentery.
44900......... ....... Drain app 8.82 11.79 10.14 .......... agree 10.14
abscess, open.
44950......... ....... Appendectomy... 8.70 8.37 10.00 .......... agree 10.00
44960......... ....... Appendectomy... 10.74 13.67 12.34 .......... agree 12.34
44970......... ....... Laparoscopy, 8.70 10.26 8.70 .......... agree 8.70
appendectomy.
45000......... ....... Drainage of 4.52 10.29 3.88 .......... increase 4.52
pelvic abscess.
45020......... ....... Drainage of 4.72 7.71 4.05 .......... increase 4.72
rectal abscess.
45100......... ....... Biopsy of 3.68 4.34 3.16 .......... increase 3.68
rectum.
45108......... ....... Removal of 4.76 5.25 4.09 .......... increase 4.76
anorectal
lesion.
45110......... ....... Removal of 23.80 29.53 28.00 .......... agree 28.00
rectum.
45111......... ....... Partial removal 16.48 N/A 16.48 .......... agree 16.48
of rectum.
45112......... ....... Removal of 25.96 32.46 30.54 .......... agree 30.54
rectum.
45113......... ....... Partial 25.99 33.11 30.58 .......... agree 30.58
proctectomy.
45114......... ....... Partial removal 23.22 29.46 27.32 .......... agree 27.32
of rectum.
45116......... ....... Partial removal 20.89 21.98 24.58 .......... agree 24.58
of rectum.
45119......... ....... Remove rectum w/ 26.21 31.60 30.84 .......... agree 30.84
reservoir.
45120......... ....... Removal of 24.60 31.09 24.60 .......... agree 24.60
rectum.
45121......... ....... Removal of 27.04 32.14 27.04 .......... agree 27.04
rectum and
colon.
45123......... ....... Partial 14.20 22.51 16.71 .......... agree 16.71
proctectomy.
45126......... ....... Pelvic 38.39 47.99 45.16 .......... agree 45.16
exenteration.
45130......... ....... Excision of 13.97 14.26 16.44 .......... agree 16.44
rectal
prolapse.
45135......... ....... Excision of 16.39 30.14 19.28 .......... agree 19.28
rectal
prolapse.
45160......... ....... Excision of 13.02 19.86 15.32 .......... agree 15.32
rectal lesion.
45170......... ....... Excision of 9.77 12.81 11.49 .......... agree 11.49
rectal lesion.
45190......... ....... Destruction, 8.28 9.09 9.74 .......... agree 9.74
rectal tumor.
45305......... ....... Proctosigmoidos 1.01 1.22 1.01 .......... agree 1.01
copy & biopsy.
45309......... ....... Proctosigmoidos 2.01 2.45 2.01 .......... agree 2.01
copy.
45330......... ....... Diagnostic 0.96 1.39 0.96 .......... agree 0.96
sigmoidoscopy.
45337......... ....... Sigmoidoscopy & 2.36 N/A 2.36 .......... agree 2.36
decompress.
45339......... ....... Sigmoidoscopy.. 3.14 N/A 3.14 .......... agree 3.14
45378......... ....... Diagnostic 3.70 4.66 3.70 .......... agree 3.70
colonoscopy.
45380......... ....... Colonoscopy and 4.01 5.01 4.44 .......... decrease 4.01
biopsy.
45383......... ....... Lesion removal 5.87 7.34 5.87 .......... agree 5.87
colonoscopy.
45384......... ....... Colonoscopy.... 4.70 5.88 4.70 .......... agree 4.70
45385......... ....... Lesion removal 5.31 6.64 5.31 .......... agree 5.31
colonoscopy.
45505......... ....... Repair of 6.02 7.57 7.58 .......... agree 7.58
rectum.
45540......... ....... Correct rectal 12.92 17.79 16.27 .......... agree 16.27
prolapse.
[[Page 31040]]
45541......... ....... Correct rectal 10.64 13.23 13.40 .......... agree 13.40
prolapse.
45550......... ....... Repair rectum/ 18.26 27.91 23.00 .......... agree 23.00
remove sigmoid.
45560......... ....... Repair of 8.40 7.70 10.58 .......... agree 10.58
rectocele.
45562......... ....... Exploration/ 12.21 12.09 15.38 .......... agree 15.38
repair of
rectum.
45563......... ....... Exploration/ 18.63 21.50 23.47 .......... agree 23.47
repair of
rectum.
45800......... ....... Repair rect/ 14.11 14.36 17.77 .......... agree 17.77
bladder
fistula.
45805......... ....... Repair fistula 16.50 20.94 20.78 .......... agree 20.78
w/colostomy.
45820......... ....... Repair 14.67 13.81 18.48 .......... agree 18.48
rectourethral
fistula.
45825......... ....... Repair fistula 16.87 20.38 21.25 .......... agree 21.25
w/colostomy.
45900......... ....... Reduction of 1.83 3.27 2.61 .......... agree 2.61
rectal
prolapse.
45905......... ....... Dilation of 1.61 3.15 2.30 .......... agree 2.30
anal sphincter.
45910......... ....... Dilation of 1.96 3.23 2.80 .......... agree 2.80
rectal
narrowing.
45910......... ....... Dilation of 1.96 N/A 2.80 .......... agree 2.80
rectal
narrowing.
45915......... ....... Remove rectal 2.20 3.58 3.14 .......... agree 3.14
obstruction.
46040......... ....... Incision of 4.96 5.53 4.26 .......... increase 4.96
rectal abscess.
46045......... ....... Incision of 4.32 5.38 3.71 .......... increase 4.32
rectal abscess.
46060......... ....... Incision of 5.69 8.55 4.89 .......... increase 5.69
rectal abscess.
46083......... ....... Incise external 1.40 1.52 1.40 .......... agree 1.40
hemorrhoid.
46083......... ....... Incise external 1.40 2.34 1.40 .......... agree 1.40
hemorrhoid.
46221......... ....... Ligation of 1.43 1.94 2.04 .......... agree 2.04
hemorrhoid(s).
46230......... ....... Removal of anal 2.57 1.94 2.57 .......... agree 2.57
tabs.
46250......... ....... Hemorrhoidectom 4.53 4.13 3.89 .......... agree 3.89
y.
46255......... ....... Hemorrhoidectom 5.36 4.98 4.60 .......... agree 4.60
y.
46257......... ....... Remove 6.28 5.43 5.40 .......... agree 5.40
hemorrhoids &
fissure.
46258......... ....... Remove 6.67 5.86 5.73 .......... agree 5.73
hemorrhoids &
fistula.
46258......... ....... Remove 6.67 N/A 5.73 .......... agree 5.73
hemorrhoids &
fistula.
46260......... ....... Hemorrhoidectom 7.42 6.18 6.37 .......... agree 6.37
y.
46261......... ....... Remove 8.24 7.11 7.08 .......... agree 7.08
hemorrhoids &
fissure.
46262......... ....... Remove 8.73 7.11 7.50 .......... agree 7.50
hemorrhoids &
fistula.
46270......... ....... Removal of anal 3.72 4.28 3.20 .......... increase 3.72
fistula.
46275......... ....... Removal of anal 4.56 5.18 3.92 .......... increase 4.56
fistula.
46280......... ....... Removal of anal 5.98 5.95 5.14 .......... increase 5.98
fistula.
46288......... ....... Repair anal 7.13 8.08 6.13 .......... increase 7.13
fistula.
46320......... ....... Removal of 1.61 1.52 1.61 .......... agree 1.61
hemorrhoid
clot.
46320......... ....... Removal of 1.61 2.63 1.61 .......... agree 1.61
hemorrhoid
clot.
46700......... ....... Repair of anal 7.25 10.22 9.13 .......... agree 9.13
stricture.
46705......... ....... Repair of anal 7.17 6.90 6.90 .......... agree 6.90
stricture.
46715......... ....... Repair of 7.46 7.20 7.20 .......... agree 7.20
anovaginal
fistula.
46716......... ....... Repair of 12.15 15.15 15.07 .......... agree 15.07
anovaginal
fistula.
46730......... ....... Construction of 21.57 25.50 26.75 .......... agree 26.75
absent anus.
46735......... ....... Construction of 25.94 36.00 32.17 .......... agree 32.17
absent anus.
46740......... ....... Construction of 23.11 35.00 30.00 .......... agree 30.00
absent anus.
46742......... ....... Repair of 29.67 38.00 35.80 .......... agree 35.80
imperforated
anus.
46744......... ....... Repair of 33.21 52.00 52.63 .......... agree 52.63
cloacal
anomaly.
46746......... ....... Repair of 36.74 53.50 58.22 .......... agree 58.22
cloacal
anomaly.
46748......... ....... Repair of 40.52 55.00 64.21 .......... agree 64.21
cloacal
anomaly.
46750......... ....... Repair of anal 8.14 10.99 10.25 .......... agree 10.25
sphincter.
46753......... ....... Reconstruction 6.58 5.45 8.29 .......... agree 8.29
of anus.
46754......... ....... Removal of 1.54 2.93 2.20 .......... agree 2.20
suture from
anus.
46760......... ....... Repair of anal 11.46 21.77 14.43 .......... agree 14.43
sphincter.
46761......... ....... Repair of anal 10.99 12.15 13.84 .......... agree 13.84
sphincter.
46762......... ....... Implant 10.09 15.01 12.71 .......... agree 12.71
artificial
sphincter.
46900......... ....... Destruction, 1.91 1.32 1.91 .......... agree 1.91
anal lesion(s).
46910......... ....... Destruction, 1.86 1.72 1.86 .......... agree 1.86
anal lesion(s).
46916......... ....... Cryosurgery, 1.86 1.72 1.86 .......... agree 1.86
anal lesion(s).
46917......... ....... Laser surgery, 1.86 3.32 1.86 .......... agree 1.86
anal lesions.
46922......... ....... Excision of 1.86 3.12 1.86 .......... agree 1.86
anal lesion(s).
46924......... ....... Destruction, 2.76 3.93 2.76 .......... agree 2.76
anal lesion(s).
46924......... ....... Destruction, 2.76 4.24 2.76 .......... agree 2.76
anal lesion(s).
46934......... ....... Destruction of 4.08 4.63 3.51 .......... agree 3.51
hemorrhoids.
46935......... ....... Destruction of 2.43 4.17 2.43 .......... agree 2.43
hemorrhoids.
46936......... ....... Destruction of 4.30 5.12 3.69 .......... agree 3.69
hemorrhoids.
46940......... ....... Treatment of 2.32 1.71 2.32 .......... agree 2.32
anal fissure.
46942......... ....... Treatment of 2.04 1.71 2.04 .......... agree 2.04
anal fissure.
46945......... ....... Ligation of 2.14 2.37 1.84 .......... agree 1.84
hemorrhoids.
46946......... ....... Ligation of 3.00 2.57 2.58 .......... agree 2.58
hemorrhoids.
[[Page 31041]]
47010......... ....... Open drainage, 10.28 16.25 16.01 .......... agree 16.01
liver lesion.
47015......... ....... Inject/aspirate 9.70 19.15 15.11 .......... agree 15.11
liver cyst.
47100......... ....... Wedge biopsy of 7.49 9.24 11.67 .......... agree 11.67
liver.
47120......... ....... Partial removal 22.79 39.57 35.50 .......... agree 35.50
of liver.
47122......... ....... Extensive 35.39 53.02 55.13 .......... agree 55.13
removal of
liver.
47125......... ....... Partial removal 31.58 44.50 49.19 .......... agree 49.19
of liver.
47130......... ....... Partial removal 34.25 46.45 53.35 .......... agree 53.35
of liver.
47134......... ....... Partial 39.15 49.00 CPT .......... CPT 39.15
removal, donor
liver.
47300......... ....... Surgery for 9.68 12.45 15.08 .......... agree 15.08
liver lesion.
47350......... ....... Repair liver 12.56 19.16 19.56 .......... agree 19.56
wound.
47360......... ....... Repair liver 17.28 28.64 26.92 .......... agree 26.92
wound.
47361......... ....... Repair liver 30.25 40.14 47.12 .......... agree 47.12
wound.
47362......... ....... Repair liver 11.88 24.94 18.51 .......... agree 18.51
wound.
47400......... ....... Incision of 20.86 35.12 32.49 .......... agree 32.49
liver duct.
47420......... ....... Incision of 16.72 27.63 19.88 .......... agree 19.88
bile duct.
47425......... ....... Incision of 16.68 32.49 19.83 .......... agree 19.83
bile duct.
47460......... ....... Incise bile 15.17 25.74 18.04 .......... agree 18.04
duct sphincter.
47480......... ....... Incision of 9.10 15.26 10.82 .......... agree 10.82
gallbladder.
47562......... ....... Laparoscopic 11.09 9.59 11.09 .......... agree 11.09
cholecystectom
y.
47563......... ....... Laparoscopic 11.94 12.40 11.94 .......... agree 11.94
cholecystectom
y.
47564......... ....... Laparo 14.23 17.67 14.23 .......... agree 14.23
cholecystectom
y/explr.
47570......... ....... Laparo 12.58 18.62 12.58 .......... agree 12.58
cholecystoente
rostomy.
47600......... ....... Removal of 11.42 11.67 13.58 .......... agree 13.58
gallbladder.
47605......... ....... Removal of 12.36 13.26 14.69 .......... agree 14.69
gallbladder.
47610......... ....... Removal of 15.83 17.97 18.82 .......... agree 18.82
gallbladder.
47612......... ....... Removal of 15.80 22.68 18.78 .......... agree 18.78
gallbladder.
47620......... ....... Removal of 17.36 24.70 20.64 .......... agree 20.64
gallbladder.
47701......... ....... Bile duct 27.81 36.50 27.81 .......... agree 27.81
revision.
47711......... ....... Excision of 19.37 31.38 23.03 .......... agree 23.03
bile duct
tumor.
47712......... ....... Excision of 25.44 38.58 30.24 .......... agree 30.24
bile duct
tumor.
47715......... ....... Excision of 15.81 32.81 18.80 .......... agree 18.80
bile duct cyst.
47716......... ....... Fusion of bile 13.83 19.34 16.44 .......... agree 16.44
duct cyst.
47720......... ....... Fuse 13.38 18.16 15.91 .......... agree 15.91
gallbladder &
bowel.
47721......... ....... Fuse upper gi 16.08 21.91 19.12 .......... agree 19.12
structures.
47740......... ....... Fuse 15.54 20.63 18.48 .......... agree 18.48
gallbladder &
bowel.
47741......... ....... Fuse 17.95 24.39 21.34 .......... agree 21.34
gallbladder &
bowel.
47760......... ....... Fuse bile ducts 21.74 21.91 25.85 .......... agree 25.85
and bowel.
47765......... ....... Fuse liver 20.93 30.62 24.88 .......... agree 24.88
ducts & bowel.
47780......... ....... Fuse bile ducts 22.29 26.86 26.50 .......... agree 26.50
and bowel.
47785......... ....... Fuse bile ducts 26.23 36.32 31.18 .......... agree 31.18
and bowel.
47800......... ....... Reconstruction 19.60 26.89 23.30 .......... agree 23.30
of bile ducts.
47801......... ....... Placement, bile 12.76 23.47 15.17 .......... agree 15.17
duct support.
47802......... ....... Fuse liver duct 18.13 34.11 21.55 .......... agree 21.55
& intestine.
47900......... ....... Suture bile 16.74 20.50 19.90 .......... agree 19.90
duct injury.
48000......... ....... Drainage of 14.91 40.79 28.07 .......... agree 28.07
abdomen.
48001......... ....... Placement of 18.83 55.20 35.45 .......... agree 35.45
drain,
pancreas.
48005......... ....... Resect/debride 22.40 57.70 42.17 .......... agree 42.17
pancreas.
48020......... ....... Removal of 14.22 23.50 15.70 .......... agree 15.70
pancreatic
stone.
48100......... ....... Biopsy of 11.08 14.57 12.23 .......... agree 12.23
pancreas.
48120......... ....... Removal of 14.36 26.05 15.85 .......... agree 15.85
pancreas
lesion.
48140......... ....... Partial removal 20.78 28.60 22.94 .......... agree 22.94
of pancreas.
48145......... ....... Partial removal 21.76 34.32 24.02 .......... agree 24.02
of pancreas.
48146......... ....... Pancreatectomy. 23.91 45.57 26.40 .......... agree 26.40
48148......... ....... Removal of 15.71 25.00 17.34 .......... agree 17.34
pancreatic
duct.
48150......... ....... Partial removal 43.48 54.73 48.00 .......... agree 48.00
of pancreas.
48150......... ....... Partial removal 43.48 54.75 48.00 .......... agree 48.00
of pancreas.
48152......... ....... Pancreatectomy. 39.63 39.63 43.75 .......... agree 43.75
48153......... ....... Pancreatectomy. 43.38 54.73 47.89 .......... agree 47.89
48154......... ....... Pancreatectomy. 39.95 51.80 44.10 .......... agree 44.10
48155......... ....... Removal of 22.32 44.70 24.64 .......... agree 24.64
pancreas.
48180......... ....... Fuse pancreas 22.39 32.52 24.72 .......... agree 24.72
and bowel.
48500......... ....... Surgery of 13.84 18.99 15.28 .......... agree 15.28
pancreas cyst.
48510......... ....... Drain 12.96 16.08 14.31 .......... agree 14.31
pancreatic
pseudocyst.
48520......... ....... Fuse pancreas 14.12 19.68 15.59 .......... agree 15.59
cyst and bowel.
48540......... ....... Fuse pancreas 17.86 21.28 19.72 .......... agree 19.72
cyst and bowel.
48545......... ....... Pancreatorrhaph 16.47 33.39 18.18 .......... agree 18.18
y.
[[Page 31042]]
48547......... ....... Duodenal 23.40 41.76 25.83 .......... agree 25.83
exclusion.
49000......... ....... Exploration of 11.68 13.42 11.68 .......... agree 11.68
abdomen.
49002......... ....... Reopening of 10.49 12.67 10.49 .......... agree 10.49
abdomen.
49010......... ....... Exploration 12.28 15.06 12.28 .......... agree 12.28
behind abdomen.
49020......... ....... Drain abdominal 16.79 28.33 20.73 .......... increase 22.84
abscess.
49040......... ....... Drain, open, 9.94 23.60 12.27 .......... increase 13.52
abdom abscess.
49060......... ....... Drain, open, 11.66 19.52 14.40 .......... increase 15.86
retrop abscess.
49085......... ....... Remove abdomen 8.93 14.23 11.03 .......... increase 12.14
foreign body.
49200......... ....... Removal of 10.25 12.19 10.25 .......... agree 10.25
abdominal
lesion.
49201......... ....... Removal of 14.84 16.27 14.84 .......... agree 14.84
abdominal
lesion.
49215......... ....... Excise sacral 22.36 24.96 33.50 .......... agree 33.50
spine tumor.
49215......... ....... Excise sacral 22.36 30.00 33.50 .......... agree 33.50
spine tumor.
49220......... ....... Multiple 14.88 17.39 14.88 .......... agree 14.88
surgery,
abdomen.
49255......... ....... Removal of 11.14 13.42 11.14 .......... agree 11.14
omentum.
49320......... ....... Diag laparo 5.10 5.95 5.10 .......... agree 5.10
separate proc.
49321......... ....... Laparoscopy; 5.40 N/A 5.40 .......... agree 5.40
biopsy.
49322......... ....... Laparoscopy; 5.70 N/A 5.70 .......... agree 5.70
aspiration.
49421......... ....... Insert 5.54 6.99 5.54 .......... agree 5.54
abdominal
drain.
49422......... ....... Remove perm 6.25 6.35 6.25 .......... agree 6.25
cannula/
catheter.
49425......... ....... Insert abdomen- 11.37 13.82 11.37 .......... agree 11.37
venous drain.
49426......... ....... Revise abdomen- 9.63 11.10 9.63 .......... agree 9.63
venous shunt.
49428......... ....... Ligation of 2.38 5.38 6.06 .......... agree 6.06
shunt.
49429......... ....... Removal of 7.40 9.57 7.40 .......... agree 7.40
shunt.
49495......... ....... Repair inguinal 5.89 6.96 CPT .......... CPT 5.89
hernia, init.
49495......... ....... Repair inguinal 5.89 12.50 CPT .......... CPT 5.89
hernia, init.
49496......... ....... Repair inguinal 8.79 10.56 CPT .......... CPT 8.79
hernia, init.
49496......... ....... Repair inguinal 8.79 14.00 CPT .......... CPT 8.79
hernia, init.
49500......... ....... Repair inguinal 4.68 7.61 5.48 .......... agree 5.48
hernia.
49501......... ....... Repair inguinal 7.58 9.26 8.88 .......... agree 8.88
hernia, init.
49505......... ....... Repair inguinal 6.49 8.31 7.60 .......... agree 7.60
hernia.
49505......... ....... Repair inguinal 6.49 11.50 7.60 .......... agree 7.60
hernia.
49507......... ....... Repair inguinal 8.17 11.38 9.57 .......... agree 9.57
hernia.
49520......... ....... Rerepair 8.22 11.02 9.63 .......... agree 9.63
inguinal
hernia.
49521......... ....... Repair inguinal 10.22 13.97 11.97 .......... agree 11.97
hernia, rec.
49525......... ....... Repair inguinal 7.32 8.36 8.57 .......... agree 8.57
hernia.
49540......... ....... Repair lumbar 8.87 8.52 10.39 .......... agree 10.39
hernia.
49550......... ....... Repair femoral 7.37 8.36 8.63 .......... agree 8.63
hernia.
49553......... ....... Repair femoral 8.06 10.31 9.44 .......... agree 9.44
hernia, init.
49555......... ....... Repair femoral 7.71 8.50 9.03 .......... agree 9.03
hernia.
49557......... ....... Repair femoral 9.52 11.82 11.15 .......... agree 11.15
hernia, recur.
49560......... ....... Repair 9.88 11.69 11.57 .......... agree 11.57
abdominal
hernia.
49561......... ....... Repair 12.17 15.67 14.25 .......... agree 14.25
incisional
hernia.
49565......... ....... Rerepair 9.88 14.03 11.57 .......... agree 11.57
abdominal
hernia.
49566......... ....... Repair 12.30 16.43 14.40 .......... agree 14.40
incisional
hernia.
49570......... ....... Repair 4.86 7.00 5.69 .......... agree 5.69
epigastric
hernia.
49572......... ....... Repair 5.75 9.77 6.73 .......... agree 6.73
epigastric
hernia.
49580......... ....... Repair 3.51 5.71 4.11 .......... agree 4.11
umbilical
hernia.
49582......... ....... Repair 5.68 9.99 6.65 .......... agree 6.65
umbilical
hernia.
49585......... ....... Repair 5.32 5.71 6.23 .......... agree 6.23
umbilical
hernia.
49587......... ....... Repair 6.46 9.34 7.56 .......... agree 7.56
umbilical
hernia.
49590......... ....... Repair 7.29 9.54 8.54 .......... agree 8.54
abdominal
hernia.
49605......... ....... Repair 22.66 97.62 76.00 .......... decrease 22.66
umbilical
lesion.
49606......... ....... Repair 18.60 21.31 18.60 .......... agree 18.60
umbilical
lesion.
49650......... ....... Laparo hernia 6.27 7.66 6.27 .......... agree 6.27
repair initial.
49651......... ....... Laparo hernia 8.24 7.88 8.24 .......... agree 8.24
repair recur.
49900......... ....... Repair of 12.28 16.92 12.28 .......... agree 12.28
abdominal wall.
49905......... ....... Omental flap... 6.55 17.79 CPT .......... CPT 6.55
50200......... ....... Biopsy of 2.63 N/A CPT .......... CPT 2.63
kidney.
50230......... ....... Removal of 22.07 N/A CPT .......... CPT 22.07
kidney.
51595......... ....... Remove bladder/ 37.14 N/A 37.14 .......... agree 37.14
revise tract.
51596......... ....... Remove bladder/ 39.52 N/A 39.52 .......... agree 39.52
create pouch.
52300......... ....... Cystoscopy and 5.31 WD (e) .......... (a) 5.31
treatment.
52327......... ....... Cystoscopy, 5.19 WD (e) .......... (a) 5.19
inject
material.
52340......... ....... Cystoscopy and 9.68 WD (e) .......... (a) 9.68
treatment.
56515......... ....... Destruction, 1.88 3.09 2.76 .......... agree 2.76
vulva
lesion(s).
56740......... ....... Remove vagina 3.76 5.74 4.57 .......... agree 4.57
gland lesion.
[[Page 31043]]
57100......... ....... Biopsy of 0.97 1.90 1.20 .......... agree 1.20
vagina.
57130......... ....... Remove vagina 2.43 5.67 2.43 .......... agree 2.43
lesion.
57292......... ....... Construct 13.09 N/A 13.09 .......... agree 13.09
vagina with
graft.
57307......... ....... Fistula repair 15.93 20.24 15.93 .......... agree 15.93
& colostomy.
57410......... ....... Pelvic 1.75 4.08 1.75 .......... agree 1.75
examination.
57505......... ....... Endocervical 1.14 0.97 1.14 .......... agree 1.14
curettage.
57555......... ....... Remove cervix/ 8.95 WD (e) .......... (a) 8.95
repair vagina.
58150......... ....... Total 15.24 17.75 15.24 .......... agree 15.24
hysterectomy.
58152......... ....... Total 15.09 20.60 20.60 .......... agree 20.60
hysterectomy.
58260......... ....... Vaginal 12.20 12.98 12.98 .......... agree 12.98
hysterectomy.
58262......... ....... Vaginal 13.99 17.88 14.77 .......... agree 14.77
hysterectomy.
58263......... ....... Vaginal 15.28 21.26 16.06 .......... agree 16.06
hysterectomy.
58267......... ....... Hysterectomy & 15.00 17.55 17.04 .......... agree 17.04
vagina repair.
58270......... ....... Hysterectomy & 13.48 15.58 14.26 .......... agree 14.26
vagina repair.
58275......... ....... Hysterectomy/ 14.98 N/A 15.76 .......... agree 15.76
revise vagina.
58280......... ....... Hysterectomy/ 15.41 N/A 17.01 .......... agree 17.01
revise vagina.
58285......... ....... Extensive 18.57 N/A 22.26 .......... agree 22.26
hysterectomy.
58323......... ....... Sperm washing.. 0.23 0.55 0.23 .......... agree 0.23
58400......... ....... Suspension of 6.36 11.68 6.36 .......... agree 6.36
uterus.
58600......... ....... Division of 3.84 4.60 5.60 .......... agree 5.60
fallopian tube.
58605......... ....... Division of 3.34 4.60 5.00 .......... agree 5.00
fallopian tube.
58611......... ....... Ligate 0.63 N/A 1.45 .......... agree 1.45
oviduct(s) add-
on.
58700......... ....... Removal of 6.49 11.68 12.05 .......... agree 12.05
fallopian tube.
58740......... ....... Revise 5.83 11.29 14.00 .......... agree 14.00
fallopian
tube(s).
58805......... ....... Drainage of 5.88 11.68 5.88 .......... agree 5.88
ovarian
cyst(s).
58820......... ....... Drain ovary 4.22 6.03 4.22 .......... agree 4.22
abscess, open.
58825......... ....... Transposition, 6.13 11.68 10.98 .......... agree 10.98
ovary(s).
58920......... ....... Partial removal 6.78 11.68 11.36 .......... agree 11.36
of ovary(s).
58950......... ....... Resect ovarian 15.27 16.93 16.93 .......... agree 16.93
malignancy.
58951......... ....... Resect ovarian 21.81 28.99 22.38 .......... agree 22.38
malignancy.
59150......... ....... Treat ectopic 6.89 11.67 11.67 .......... agree 11.67
pregnancy.
59151......... ....... Treat ectopic 7.86 11.49 11.49 .......... agree 11.49
pregnancy.
59812......... ....... Treatment of 3.25 4.01 4.01 .......... agree 4.01
miscarriage.
59870......... ....... Evacuate mole 4.28 5.00 6.01 .......... agree 6.01
of uterus.
60100......... ....... Biopsy of 0.97 1.88 1.56 .......... agree 1.56
thyroid.
60220......... ....... Partial removal 10.53 11.82 11.90 .......... agree 11.90
of thyroid.
60220......... ....... Partial removal 10.53 14.24 11.90 .......... agree 11.90
of thyroid.
60252......... ....... Removal of 18.20 22.32 20.57 .......... agree 20.57
thyroid.
60254......... ....... Extensive 23.88 27.43 26.99 .......... agree 26.99
thyroid
surgery.
60260......... ....... Repeat thyroid 15.46 18.83 17.47 .......... agree 17.47
surgery.
60270......... ....... Removal of 17.94 23.05 20.27 .......... agree 20.27
thyroid.
60271......... ....... Removal of 14.89 18.68 16.83 .......... agree 16.83
thyroid.
60280......... ....... Remove thyroid 6.08 WD (e) .......... (a) 6.08
duct lesion.
60540......... ....... Explore adrenal 17.03 20.53 17.03 .......... agree 17.03
gland.
60545......... ....... Explore adrenal 19.88 25.66 19.88 .......... agree 19.88
gland.
62263......... ....... Lysis epidural 6.14 7.20 7.20 .......... (b) 6.14
adhesions.
62310......... ....... Inject spine c/ 1.91 1.95 2.20 .......... (b) 1.91
t.
62311......... ....... Inject spine l/ 1.54 1.57 1.78 .......... (b) 1.54
s (cd).
62318......... ....... Inject spine w/ 2.04 2.26 2.35 .......... (b) 2.04
cath, c/t.
62319......... ....... Inject spine w/ 1.87 1.88 2.15 .......... (b) 1.87
cath l/s (cd).
65855......... ....... Laser surgery 4.30 N/A 3.85 .......... agree 3.85
of eye.
66170......... ....... Glaucoma 12.16 WD (e) .......... (a) 12.16
surgery.
66172......... ....... Incision of eye 15.04 WD (e) .......... (a) 15.04
66180......... ....... Implant eye 14.55 N/A 14.55 .......... agree 14.55
shunt.
66986......... ....... Exchange lens 12.28 N/A 12.28 .......... agree 12.28
prosthesis.
67028......... ....... Injection eye 2.52 N/A 2.52 .......... agree 2.52
drug.
67108......... ....... Repair detached 20.82 WD (e) .......... (a) 20.82
retina.
67218......... ....... Treatment of 13.52 N/A 18.53 .......... agree 18.53
retinal lesion.
67904......... ....... Repair eyelid 6.26 N/A 6.26 .......... agree 6.26
defect.
69000......... ....... Drain external 1.45 WD (e) .......... (a) 1.45
ear lesion.
69005......... ....... Drain external 2.11 WD (e) .......... (a) 2.11
ear lesion.
69020......... ....... Drain outer ear 1.48 WD (e) .......... (a) 1.48
canal lesion.
69100......... ....... Biopsy of 0.81 WD (e) .......... (a) 0.81
external ear.
69105......... ....... Biopsy of 0.85 WD (e) .......... (a) 0.85
external ear
canal.
69110......... ....... Remove external 3.44 WD (e) .......... (a) 3.44
ear, partial.
69120......... ....... Removal of 4.05 WD (e) .......... (a) 4.05
external ear.
[[Page 31044]]
69140......... ....... Remove ear 7.97 WD (e) .......... (a) 7.97
canal
lesion(s).
69145......... ....... Remove ear 2.62 WD (e) .......... (a) 2.62
canal
lesion(s).
69150......... ....... Extensive ear 13.43 WD (e) .......... (a) 13.43
canal surgery.
69155......... ....... Extensive ear/ 20.80 WD (e) .......... (a) 20.80
neck surgery.
69200......... ....... Clear outer ear 0.77 WD (e) .......... (a) 0.77
canal.
69205......... ....... Clear outer ear 1.20 WD (e) .......... (a) 1.20
canal.
69210......... ....... Remove impacted 0.61 WD (e) .......... (a) 0.61
ear wax.
69220......... ....... Clean out 0.83 WD (e) .......... (a) 0.83
mastoid cavity.
69222......... ....... Clean out 1.40 WD (e) .......... (a) 1.40
mastoid cavity.
69300......... ....... Revise external 6.36 WD (e) .......... (a) 6.36
ear.
69310......... ....... Rebuild outer 10.79 WD (e) .......... (a) 10.79
ear canal.
69320......... ....... Rebuild outer 16.96 WD (e) .......... (a) 16.96
ear canal.
69400......... ....... Inflate middle 0.83 WD (e) .......... (a) 0.83
ear canal.
69401......... ....... Inflate middle 0.63 WD (e) .......... (a) 0.63
ear canal.
69405......... ....... Catheterize 2.63 WD (e) .......... (a) 2.63
middle ear
canal.
69410......... ....... Inset middle 0.33 WD (e) .......... (a) 0.33
ear (baffle).
69420......... ....... Incision of 1.33 WD (e) .......... (a) 1.33
eardrum.
69421......... ....... Incision of 1.73 WD (e) .......... (a) 1.73
eardrum.
69424......... ....... Remove 0.85 WD (e) .......... (a) 0.85
ventilating
tube.
69433......... ....... Create eardrum 1.52 WD (e) .......... (a) 1.52
opening.
69436......... ....... Create eardrum 1.96 WD (e) .......... (a) 1.96
opening.
69440......... ....... Exploration of 7.57 WD (e) .......... (a) 7.57
middle ear.
69450......... ....... Eardrum 5.57 WD (e) .......... (a) 5.57
revision.
69501......... ....... Mastoidectomy.. 9.07 WD (e) .......... (a) 9.07
69502......... ....... Mastoidectomy.. 12.38 WD (e) .......... (a) 12.38
69505......... ....... Remove mastoid 12.99 WD (e) .......... (a) 12.99
structures.
69511......... ....... Extensive 13.52 WD (e) .......... (a) 13.52
mastoid
surgery.
69530......... ....... Extensive 19.19 WD (e) .......... (a) 19.19
mastoid
surgery.
69535......... ....... Remove part of 36.14 WD (e) .......... (a) 36.14
temporal bone.
69540......... ....... Remove ear 1.20 WD (e) .......... (a) 1.20
lesion.
69550......... ....... Remove ear 10.99 WD (e) .......... (a) 10.99
lesion.
69552......... ....... Remove ear 19.46 WD (e) .......... (a) 19.46
lesion.
69554......... ....... Remove ear 33.16 WD (e) .......... (a) 33.16
lesion.
69601......... ....... Mastoid surgery 13.24 WD (e) .......... (a) 13.24
revision.
69602......... ....... Mastoid surgery 13.58 WD (e) .......... (a) 13.58
revision.
69603......... ....... Mastoid surgery 14.02 WD (e) .......... (a) 14.02
revision.
69604......... ....... Mastoid surgery 14.02 WD (e) .......... (a) 14.02
revision.
69605......... ....... Remove mastoid 18.49 WD (e) .......... (a) 18.49
structures.
69610......... ....... Repair of 4.43 WD (e) .......... (a) 4.43
eardrum.
69620......... ....... Repair of 5.89 WD (e) .......... (a) 5.89
eardrum.
69631......... ....... Rebuild eardrum 9.86 WD (e) .......... (a) 9.86
structures.
69632......... ....... Rebuild eardrum 12.75 WD (e) .......... (a) 12.75
structures.
69633......... ....... Rebuild eardrum 12.10 WD (e) .......... (a) 12.10
structures.
69635......... ....... Repair eardrum 13.33 WD (e) .......... (a) 13.33
structures.
69636......... ....... Rebuild eardrum 15.22 WD (e) .......... (a) 15.22
structures.
69637......... ....... Rebuild eardrum 15.11 WD (e) .......... (a) 15.11
structures.
69641......... ....... Revise middle 12.71 WD (e) .......... (a) 12.71
ear & mastoid.
69642......... ....... Revise middle 16.84 WD (e) .......... (a) 16.84
ear & mastoid.
69643......... ....... Revise middle 15.32 WD (e) .......... (a) 15.32
ear & mastoid.
69644......... ....... Revise middle 16.97 WD (e) .......... (a) 16.97
ear & mastoid.
69645......... ....... Revise middle 16.38 WD (e) .......... (a) 16.38
ear & mastoid.
69646......... ....... Revise middle 17.99 WD (e) .......... (a) 17.99
ear & mastoid.
69650......... ....... Release middle 9.66 WD (e) .......... (a) 9.66
ear bone.
69660......... ....... Revise middle 11.90 WD (e) .......... (a) 11.90
ear bone.
69661......... ....... Revise middle 15.74 WD (e) .......... (a) 15.74
ear bone.
69662......... ....... Revise middle 15.44 WD (e) .......... (a) 15.44
ear bone.
69666......... ....... Repair middle 9.75 WD (e) .......... (a) 9.75
ear structures.
69667......... ....... Repair middle 9.76 WD (e) .......... (a) 9.76
ear structures.
69670......... ....... Remove mastoid 11.51 WD (e) .......... (a) 11.51
air cells.
69676......... ....... Remove middle 9.52 WD (e) .......... (a) 9.52
ear nerve.
69700......... ....... Close mastoid 8.23 WD (e) .......... (a) 8.23
fistula.
69711......... ....... Remove/repair 10.44 WD (e) .......... (a) 10.44
hearing aid.
69720......... ....... Release facial 14.38 WD (e) .......... (a) 14.38
nerve.
69725......... ....... Release facial 25.38 WD (e) .......... (a) 25.38
nerve.
69740......... ....... Repair facial 15.96 WD (e) .......... (a) 15.96
nerve.
69745......... ....... Repair facial 16.69 WD (e) .......... (a) 16.69
nerve.
[[Page 31045]]
69801......... ....... Incise inner 8.56 WD (e) .......... (a) 8.56
ear.
69802......... ....... Incise inner 13.10 WD (e) .......... (a) 13.10
ear.
69805......... ....... Explore inner 13.82 WD (e) .......... (a) 13.82
ear.
69806......... ....... Explore inner 12.35 WD (e) .......... (a) 12.35
ear.
69820......... ....... Establish inner 10.34 WD (e) .......... (a) 10.34
ear window.
69840......... ....... Revise inner 10.26 WD (e) .......... (a) 10.26
ear window.
69905......... ....... Remove inner 11.10 WD (e) .......... (a) 11.10
ear.
69910......... ....... Remove inner 13.63 WD (e) .......... (a) 13.63
ear & mastoid.
69915......... ....... Incise inner 21.23 WD (e) .......... (a) 21.23
ear nerve.
69930......... ....... Implant 16.81 WD (e) .......... (a) 16.81
cochlear
device.
69950......... ....... Incise inner 25.64 WD (e) .......... (a) 25.64
ear nerve.
69955......... ....... Release facial 27.04 WD (e) .......... (a) 27.04
nerve.
69960......... ....... Release inner 27.04 WD (e) .......... (a) 27.04
ear canal.
69970......... ....... Remove inner 30.04 WD (e) .......... (a) 30.04
ear lesion.
69990......... ....... Microsurgery 3.47 N/A 3.47 .......... agree 3.47
add-on.
72275......... ....... Epidurography.. 0.76 0.83 0.83 .......... (b) 0.76
76005......... ....... Fluoroguide for 0.60 0.60 10.60 .......... agree 0.60
spine inject.
76065......... ....... X-rays, bone 0.28 0.60 0.70 .......... agree 0.70
evaluation.
76090......... ....... Mammogram, one 0.58 0.64 0.70 .......... agree 0.70
breast.
76091......... ....... Mammogram, both 0.69 0.76 0.87 .......... agree 0.87
breasts.
76095......... ....... Stereotactic 1.59 3.58 1.59 .......... agree 1.59
breast biopsy.
88170......... ....... Fine needle 1.27 3.28 1.27 .......... agree 1.27
aspiration.
88171......... ....... Fine needle 1.27 2.63 1.27 .......... agree 1.27
aspiration.
90901......... ....... Biofeedback 0.41 N/A .......... 0.41 agree 0.41
train, any
meth.
90911......... ....... Biofeedback 0.89 N/A 0.89 .......... agree 0.89
peri/uro/
rectal.
90935......... ....... Hemodialysis, 1.22 N/A CPT .......... CPT 1.22
one evaluation.
90937......... ....... Hemodialysis, 2.11 N/A CPT .......... CPT 2.11
repeated eval.
90945......... ....... Dialysis, one 1.28 N/A CPT .......... CPT 1.28
evaluation.
90947......... ....... Dialysis, 2.16 N/A CPT .......... CPT 2.16
repeated eval.
90989......... ....... Dialysis 0.00 N/A CPT .......... CPT 0.00
training,
complete.
90993......... ....... Dialysis 0.00 N/A CPT .......... CPT 0.00
training,
incompl.
90997......... ....... Hemoperfusion.. 1.84 N/A CPT .......... CPT 1.84
92018......... ....... New eye exam & 1.51 N/A 2.50 .......... agree 2.50
treatment.
93350......... ....... Echo 0.78 N/A 1.48 .......... agree 1.48
transthoracic.
94640......... ....... Airway 0.00 N/A 0.00 .......... agree 0.00
inhalation
treatment.
94664......... ....... Aerosol or 0.00 N/A CPT .......... CPT 0.00
vapor
inhalations.
94665......... ....... Aerosol or 0.00 N/A CPT .......... CPT 0.00
vapor
inhalations.
96100......... ....... Psychological 0.00 2.00 .......... (a) agree 0.00
testing.
96105......... ....... Assessment of 0.00 2.00 .......... (a) agree 0.00
aphasia.
96110......... ....... Developmental 0.00 2.00 .......... (a) agree 0.00
test, lim.
96115......... ....... Neurobehavior 0.00 2.20 .......... (a) agree 0.00
status exam.
96117......... ....... Neuropsych test 0.00 2.20 .......... (a) agree 0.00
battery.
97542......... ....... Wheelchair 0.25 0.45 .......... 0.45 agree 0.45
mngmnt
training.
99233......... ....... Subsequent 1.51 N/A 1.51 .......... agree 1.51
hospital care.
99273......... ....... Confirmatory 1.19 N/A 1.19 .......... agree 1.19
consultation.
99274......... ....... Confirmatory 1.73 N/A 1.73 .......... agree 1.73
consultation.
99291......... ....... Critical care, 3.60 4.00 4.00 .......... agree 4.00
first hour.
99291......... ....... Critical care, 3.60 5.50 4.00 .......... agree 4.00
first hour.
99291......... ....... Critical care, 3.60 N/A 4.00 .......... agree 4.00
first hour.
99292......... ....... Critical care, 1.80 2.00 2.00 .......... agree 2.00
addl 30 min.
99292......... ....... Critical care, 1.80 2.77 2.00 .......... agree 2.00
addl 30 min.
99292......... ....... Critical care, 1.80 N/A 2.00 .......... agree 2.00
addl 30 min.
99295......... ....... Neonatal 16.00 N/A 16.00 .......... agree 16.00
critical care.
99296......... ....... Neonatal 8.00 N/A 8.00 .......... agree 8.00
critical care.
99297......... ....... Neonatal 4.00 N/A 4.00 .......... agree 4.00
critical care.
99298......... ....... Neonatal 2.75 N/A 2.75 .......... agree 2.75
critical care.
99436......... ....... Attendance, 1.50 N/A 1.50 .......... agree 1.50
birth.
99440......... ....... Newborn 2.93 N/A 2.93 .......... agree 2.93
resuscitation.
G0127......... ....... Trim nail(s)... 0.11 N/A .......... (a) (a) 0.11
----------------------------------------------------------------------------------------------------------------
Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 /
Notices
[[Page 31046]]
B. Discussion of Comments by Clinical Area
1. Vascular Surgery
Comment: The Society for Vascular Surgery (SVS) and the North
American Chapter of the International Society for Cardiovascular
Surgery requested increases in work RVUs for 95 codes. Both groups
commented that vascular surgery procedures were undervalued in the
original Harvard Study and that only a small number of these RVUs have
been adjusted since that time.
The SVS's recommendations were based on surveys, a full RUC survey
of 39 higher volume codes and minisurveys for 56 less frequently
performed codes. (The full and minisurveys included estimates for each
code of pre-, intra-, and postservice times and visits as well as
estimates of physician work. The effect of these recommendations would
be to correct current rank-order anomalies, while avoiding creation of
new rank-order anomalies.) The SVS used a building-block approach to
validate the survey results for each of their codes.
RUC Recommendation
Of the 95 codes, the RUC recommended increases for 91 codes, a
decrease for 1 code and no changes for 3 codes. In 60 percent of cases,
the RUC recommendations to increase the work RVUs were based on
physician surveys. The recommendations were based on either the 25th
percentile or the median of survey responses. In almost all other
cases, the RUC recommendation for a specific code work RVU was based on
the work value of another comparable code. The building-block approach
was used only to corroborate findings from the surveys or validate a
comparison to another procedure. The following are the RUC
recommendations for the codes submitted. (Please note that throughout
this document the value in parentheses represents the RUC-recommended
work RVUs unless they are shown in columns.)
------------------------------------------------------------------------
CPT codes Work RVUs
------------------------------------------------------------------------
Family 1 Aneurysm Repairs in Abdomen
------------------------------------------------------------------------
35111............................ 25.00
35131............................ 25.00
35112............................ 30.00
35132............................ 30.00
35121............................ 30.00
35122............................ 35.00
35082............................ 38.50
35103............................ 40.50
35092............................ 45.00
------------------------------------------------------------------------
Family 2 Bypass Grafts in the Abdomen
------------------------------------------------------------------------
35665............................ 21.00
35663............................ 22.00
35565............................ 23.20
35563............................ 24.20
35636............................ 29.50
35536............................ 31.70
35560............................ 32.00
35631............................ 34.00
35531............................ 36.20
------------------------------------------------------------------------
Family 3 Embolectomy/Thrombectomy in the Abdomen
------------------------------------------------------------------------
34401............................ 25.00
34151............................ 25.00
34451............................ 27.00
------------------------------------------------------------------------
Family 4 Endarterectomy in the Abdomen
------------------------------------------------------------------------
35351............................ 23.00
35331............................ 26.20
35361............................ 28.20
35363............................ 30.20
------------------------------------------------------------------------
Family 5 Repair Blood Vessels in the Abdomen
------------------------------------------------------------------------
37660............................ 21.00
37617............................ 22.06
35221............................ 24.39
35281............................ 28.00
35251............................ 30.20
------------------------------------------------------------------------
Family 6 Explorations, Revisions, Other in Chest & Abdomen
------------------------------------------------------------------------
35189............................ 28.00
35182............................ 30.00
35905............................ 31.25
35907............................ 35.00
------------------------------------------------------------------------
[[Page 31047]]
Family 7 Extra-anatomic Bypass Grafts
------------------------------------------------------------------------
35661............................ 19.00
35650............................ 19.00
35621............................ 20.00
35558............................ 21.20
35511............................ 21.20
35518............................ 21.20
35623............................ 24.00
35521............................ 22.20
35654............................ 25.00
35533............................ 28.00
------------------------------------------------------------------------
Family 8 Arterial Bypass Grafts in Extremities
------------------------------------------------------------------------
35666............................ 22.19
35671............................ 19.23
35571............................ 24.06
35587............................ 24.75
------------------------------------------------------------------------
Family 9 Embolectomy/Thrombectomy by Extremity Incision
------------------------------------------------------------------------
34490............................ 9.86
34111............................ 10.00
34201............................ 10.03
34101............................ 10.00
34421............................ 12.00
34203............................ 16.50
------------------------------------------------------------------------
Family 10 Aneurysm Repairs in the Extremity
------------------------------------------------------------------------
35045............................ 17.57
35011............................ 18.00
35141............................ 20.00
35013............................ 22.00
35151............................ 22.64
35142............................ 23.30
35152............................ 25.62
------------------------------------------------------------------------
Family 11 Endarterectomy of Extremity Arteries
------------------------------------------------------------------------
35371............................ 14.72
35321............................ 16.00
35372............................ 18.00
35355............................ 18.50
------------------------------------------------------------------------
Family 12 Arteriovenous Fistula Repairs in the Extremities
------------------------------------------------------------------------
35190............................ No change in work RVUs
35184............................ 18.00
------------------------------------------------------------------------
Family 13 Peripheral Artery and Vein Ligations
------------------------------------------------------------------------
35721............................ 7.18
37650............................ 7.80
35741............................ 8.00
37618............................ No change in work RVUs
37565............................ 10.88
37600............................ 11.25
35701............................ 8.50
37605............................ 13.11
37615............................ No change in work RVUs
------------------------------------------------------------------------
Family 14 Vessel/Repairs in Extremities and Neck
------------------------------------------------------------------------
35201............................ 16.14
35206............................ 13.25
35226............................ 14.50
35266............................ 14.91
35261............................ 17.80
35286............................ 16.16
35236............................ 17.11
35231............................ 20.00
35256............................ 18.36
------------------------------------------------------------------------
[[Page 31048]]
Family 15 Reconstruction for Chronic Venous Disease
------------------------------------------------------------------------
34501............................ 16.00
34520............................ 17.95
34510............................ 18.95
34530............................ 16.64 (decrease)
------------------------------------------------------------------------
Family 16 Repairs, Bypass Grafts, Endarterectomies in the Chest
------------------------------------------------------------------------
35276............................ 24.25
35246............................ 26.45
35626............................ 27.75
35526............................ 29.95
35311............................ 27.00
------------------------------------------------------------------------
Family 17 Ligation or Biopsy of Temporal Artery
------------------------------------------------------------------------
37609............................ 3.00
------------------------------------------------------------------------
Family 18 Untitled
------------------------------------------------------------------------
35081............................ 28.01
35556............................ 21.76
------------------------------------------------------------------------
The RUC recommended the following codes be submitted to the CPT
Editorial Panel for further consideration: 35381, 35541, 35546, 35551,
35582, 35641, 35646, 35840, 35860, 37615, 37618, 37700, 37730, 37735,
37760, 37785.
HCFA Proposal:
We have reviewed and propose to accept all of the RUC
recommendations for the vascular surgery codes. We believe that
relativity is maintained, and the RVUs more appropriately reflect the
work involved.
2. General Surgery/Colon and Rectal Surgery
Comment: The American Society of General Surgeons (ASGS) submitted
55 codes it believed to be undervalued. The ASGS recommended work RVUs
for each service. After submitting the codes, the specialty society
ultimately chose not to pursue review of RVUs for the following codes
under the 5-year review: 20605, 34001, and 29881.
The following codes 49505, 32440, 46320, 46924, 31622, 44140 (no
change), 38500, 32480, 37609, 43239, 43638, 60220, 44050, 48150, and
38100 were also submitted for review by other specialty groups and are
discussed in other sections. (Note that codes 56305, 56341, 56300,
56340, and 56306 are laparoscopic surgery codes also submitted for
review by the specialty group; however, these services were deleted or
renumbered by CPT for 2000.)
RUC Recommendation:
The RUC recommended that the work RVUs for the following codes be
increased (the RUC-recommended work RVUs are in parentheses):
Code 36489, Placement of central venous catheter (subclavian,
jugular, or other vein (eg, 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.
For the following codes, the RUC stated that there was no
compelling evidence provided to support increasing the work RVUs.
Therefore, it recommended maintaining the current work RVUs for the
following codes: 19100, 88170, 57410, 76095, 88171, 32000, 21800,
46083, 19000, 19125, 45330, 19160, 13101, 11402, 12011, 11642, 27590,
45378, 36625, 45309, 45305, 35081, 19240, 58150, 43246, 19162, and
35556. The RUC also recommended maintaining the current work RVUs for
codes 49321 and 49322 because these services had recently been reviewed
by the RUC.
The RUC recommended that the following codes be referred to the CPT
Editorial Panel for review or clarification: 37720 and 43215.
HCFA Proposal:
We have reviewed and propose to accept all of the RUC
recommendations for these surgery codes.
Comment:
The American College of Surgeons (ACS) submitted general surgery
codes for review that account for approximately 50 percent of general
surgery's Medicare-allowed charges for services categorized as surgery
under our ``type of service'' classification. The procedures are
predominantly performed by general surgeons, and they involve the
gastrointestinal tract, abdominal organs, thyroid, lymph system, and
endocrine system. Requests for review of some of these codes were also
submitted by other specialty groups.
In its comments, the ACS emphasized that its analysis determined
that the work of codes in general surgery has been systematically
undervalued.
The ACS used a building-block approach with panel-assigned
intraoperative work intensities for procedures. Preoperative work RVUs
were determined based on an assigned intensity multiplied by the number
of preservice minutes. The assigned preservice work intensity was below
that of an evaluation and management service. A panel of ASC members
assigned intraservice work intensity to each code using a scale. The
intensity of an evaluation and management service was the low end of
the scale, and liver resection services were on the high end of the
scale. The ends of the scale were chosen to represent ``average'' work
intensity throughout a procedure. The ACS maintains that the work
intensity of any surgical procedure is greater than the work intensity
of an evaluation and management service. Postservice work RVUs were
calculated using current work RVUs for hospital visits and discounted
work RVUs for office visits. Pre, intra-, and postwork RVUs were summed
to equal the new work RVUs that the ACS developed for each code.
[[Page 31049]]
The ACS assigned over 300 codes to 31 families of similar services
(for example, all codes related to hernia repair were in one family).
It conducted a traditional RUC survey for 32 codes (either high volume
services or the service most representative of the family of codes). A
minisurvey, which did not include a respondent-recommended work value,
was conducted for the remaining codes, with participation from other
specialty groups. The ACS indicated that the survey respondents tended
to overvalue codes at the low end of the scale and undervalue codes at
the high end of the scale. As a result, ACS recommended using the 25th
percentile of survey results at the low end and the 75th percentile for
work RVUs at the high end of the scale for fully-surveyed codes.
However, they stated that acceptance of these survey results without
adjustments to other codes in the family that were not fully surveyed
would distort the relativity within and across families. They
recommended a regression methodology to extrapolate the fully-surveyed
code results to the other codes.
RUC Recommendation:
The RUC workgroup reviewed the data collected for the 32 fully-
surveyed ACS codes. It also reviewed the families of services proposed
by ACS and modified the families that were too dissimilar to permit
appropriate comparison within the family. After the anchor code was
reviewed, each family was reviewed to determine whether the change to
the anchor code should be applied to the entire family of codes. In
some instances the RUC agreed that the recommended change in the anchor
code should be extrapolated to the entire family to ensure that rank-
order and relativity distortions were not created by a change to the
anchor code. In other instances the RUC determined that the
recommendation for the anchor code did not apply to the family of
codes. In these instances, either new RVUs were recommended or the
present work RVUs were maintained. The following are the code-specific
RUC recommendations:
------------------------------------------------------------------------
CPT codes Work RVUs
------------------------------------------------------------------------
Family 1A & B Thyroid/Endocrine
------------------------------------------------------------------------
60220............................ 11.90
60252............................ 20.57
60254............................ 26.99
60260............................ 17.47
60270............................ 20.27
60271............................ 16.83
60540............................ No change
60545............................ No change
------------------------------------------------------------------------
Family 2 Lymphadenectomy
------------------------------------------------------------------------
38740............................ 8.42
38745............................ 11.00
38760............................ 10.88
38765............................ 19.98
------------------------------------------------------------------------
Family 3 Lymph Nodes and Lymphatic Channels--Incision/Excision
------------------------------------------------------------------------
38300............................ 1.99
38305............................ 6.00
38308............................ 6.45
38500............................ 3.75
38510............................ 6.43
38520............................ 6.67
38525............................ 6.07
38530............................ 7.98
------------------------------------------------------------------------
Family 4 Intestines--Excision/Incision
------------------------------------------------------------------------
44005............................ 16.23
44010............................ 12.52
44020............................ 13.99
44021............................ 14.08
44025............................ 14.28
44050............................ 14.03
44110............................ 11.81
44111............................ 14.29
44120............................ 17.00
44125............................ 17.54
44130............................ 14.49
44160............................ 18.62
44800............................ 11.23
44820............................ 12.09
------------------------------------------------------------------------
Family 5 Intestines--External Fistulization
------------------------------------------------------------------------
44300............................ 12.11
44310............................ 15.95
44312............................ 8.02
44314............................ 15.05
44316............................ 21.09
[[Page 31050]]
44320............................ 17.64
44340............................ 17.72
44345............................ 15.43
44346............................ 16.99
------------------------------------------------------------------------
Family 6 Intestines--Colectomy
------------------------------------------------------------------------
Codes 44140, 44143, 44144, 44145, 44146, 44150, 44151, 44152, 44153,
44155, and 44156. The RUC made no changes to any of these codes based
on the lack of compelling evidence.
------------------------------------------------------------------------
Family 7 intestines--Repair
------------------------------------------------------------------------
44602............................ 11.91
44603............................ 15.72
44604............................ 16.03
44605............................ 17.25
44615............................ 15.93
44620............................ 12.20
44625............................ 15.05
44626............................ 25.36
44640............................ 16.65
44650............................ 17.12
44660............................ 16.42
44661............................ 19.07
44680............................ 15.40
44700............................ 16.11
44850............................ 10.74
------------------------------------------------------------------------
Family 8 Anus/Rectum--Hemorrhoids/Fistula
------------------------------------------------------------------------
45000............................ 3.88
45020............................ 4.05
45100............................ 3.16
45108............................ 4.09
46040............................ 4.26
46045............................ 3.71
46060............................ 4.89
46250............................ 3.89
46255............................ 4.60
46257............................ 5.40
46258............................ 5.73
46260............................ 6.37
46261............................ 7.08
46262............................ 7.50
46270............................ 3.20
46275............................ 3.92
46280............................ 5.14
46288............................ 6.13
46934............................ 3.51
46936............................ 3.69
46945............................ 1.84
46946............................ 2.58
Note: All of the work RVUs for Family 8 reflect a recommended decrease
from the CY 2000 work RVUs.
------------------------------------------------------------------------
Family 9 A B &C Anus/Rectum, Anus (destruction)--10-day global
------------------------------------------------------------------------
45900............................ 2.61
45905............................ 2.30
45910............................ 2.80
45915............................ 3.14
46221............................ 2.04
46754............................ 2.20
Note: Based on the lack of compelling evidence, the RUC recommended
that no changes be made to the following Family 9 codes: 46083, 46230,
46320, 46935, 46940, 46942, 46900, 46910, 46916, 46917, 46922, and
46924.
------------------------------------------------------------------------
Family 10 Anus/Rectum Repair
------------------------------------------------------------------------
45505............................ 7.58
45540............................ 16.27
45541............................ 13.40
45550............................ 23.00
45560............................ 10.58
45562............................ 15.38
45563............................ 23.47
[[Page 31051]]
45800............................ 17.77
45805............................ 20.78
45820............................ 18.48
45825............................ 21.25
46700............................ 9.13
46750............................ 10.25
46753............................ 8.29
46760............................ 14.43
46761............................ 13.84
46762............................ 12.71
------------------------------------------------------------------------
Family 11 Hernia
------------------------------------------------------------------------
49500............................ 5.48
49501............................ 8.88
49505............................ 7.60
49507............................ 9.57
49520............................ 9.63
49521............................ 11.97
49525............................ 8.57
49540............................ 10.39
49550............................ 8.63
49553............................ 9.44
49555............................ 9.03
49557............................ 11.15
49560............................ 11.57
49561............................ 14.25
49565............................ 11.57
49566............................ 14.40
49570............................ 5.69
49572............................ 6.73
49580............................ 4.11
49582............................ 6.65
49585............................ 6.23
49587............................ 7.56
49590............................ 8.54
------------------------------------------------------------------------
Family 12 A & B Stomach--Gastrectomy and Gastrectomy/Vagotomy
------------------------------------------------------------------------
43620............................ 30.04
43621............................ 30.73
43622............................ 32.53
43638............................ 29.00
43639............................ 29.65
43631............................ 22.59
43632............................ 22.59
43633............................ 23.10
43634............................ 25.12
43640............................ 17.02
43641............................ 17.27
------------------------------------------------------------------------
Family 13 A & B Stomach--
Incision/Excision/Repair
------------------------------------------------------------------------
43500............................ 11.05
43501............................ 20.04
43502............................ 23.13
43510............................ 13.08
43520............................ 9.99
43605............................ 11.98
43610............................ 14.60
43611............................ 17.84
43800............................ 13.69
43810............................ 14.65
43820............................ 15.37
43825............................ 19.22
43830............................ 9.53
43832............................ 15.60
43840............................ 15.56
43870............................ 9.69
43842............................ 18.47
43843............................ 18.65
43846............................ 24.05
43847............................ 26.92
43848............................ 29.39
[[Page 31052]]
43850............................ 24.72
43855............................ 26.16
43860............................ 25.00
43865............................ 26.52
43880............................ 24.65
------------------------------------------------------------------------
Family 14 A Abdomen, Peritoneum, Omentum
------------------------------------------------------------------------
The RUC recommended no changes for codes 49000, 49002, 49010, 49200,
49201, 49220, 49255, 49900, 49421, 49422, 49425, 49426, and 49429.
------------------------------------------------------------------------
Family 14 B Abdomen, Peritoneum, Omentum
------------------------------------------------------------------------
49020............................ 20.73
49040............................ 12.27
49060............................ 14.40
49085............................ 11.03
------------------------------------------------------------------------
Family 14 C Abdomen, Peritoneum, Omentum
------------------------------------------------------------------------
49428............................ 6.06
------------------------------------------------------------------------
Family 15 Appendix
------------------------------------------------------------------------
44900............................ 10.14
44950............................ 10.00
44960............................ 12.34
========================================================================
Family 16 Rectum--Proctectomy/Excision
------------------------------------------------------------------------
45110............................ 28.00
45112............................ 30.54
45113............................ 30.58
45114............................ 27.32
45116............................ 24.58
45119............................ 30.84
45123............................ 16.71
45126............................ 45.16
45130............................ 16.44
45135............................ 19.28
45160............................ 15.32
45170............................ 11.49
45190............................ 9.74
------------------------------------------------------------------------
Family 17 Biliary Tract
------------------------------------------------------------------------
47420............................ 19.88
47425............................ 19.83
47460............................ 18.04
47480............................ 10.82
47600............................ 13.58
47605............................ 14.69
47610............................ 18.82
47612............................ 18.78
47620............................ 20.64
47711............................ 23.03
47712............................ 30.24
47715............................ 18.80
47716............................ 16.44
47720............................ 15.91
47721............................ 19.12
47740............................ 18.48
47741............................ 21.34
47760............................ 25.85
47765............................ 24.88
47780............................ 26.50
47785............................ 31.18
47800............................ 23.30
47801............................ 15.17
47802............................ 21.55
47900............................ 19.90
------------------------------------------------------------------------
Family 18 Esophagus--Repair/Reconstruction
------------------------------------------------------------------------
43320............................ 19.93
[[Page 31053]]
43324............................ 20.57
43325............................ 20.06
43326............................ 19.74
43330............................ 19.77
43331............................ 20.13
43340............................ 19.61
43341............................ 20.85
43350............................ 15.78
43351............................ 18.35
43352............................ 15.26
43360............................ 35.70
43361............................ 40.50
43400............................ 21.20
43401............................ 22.09
43405............................ 20.01
43410............................ 13.47
43415............................ 25.00
43420............................ 14.35
43425............................ 21.03
------------------------------------------------------------------------
Family 19 Liver
------------------------------------------------------------------------
47010............................ 16.01
47015............................ 15.11
47100............................ 11.67
47120............................ 35.50
47122............................ 55.13
47125............................ 49.19
47130............................ 53.35
47300............................ 15.08
47350............................ 19.56
47360............................ 26.92
47361............................ 47.12
47362............................ 18.51
47400............................ 32.49
------------------------------------------------------------------------
Family 20 A & B Spleen--Incision/Excision/Repair and Pancreatitis
Management
------------------------------------------------------------------------
38100............................ 14.50
38101............................ 15.31
38115............................ 15.82
48000............................ 28.07
48001............................ 35.45
48005............................ 42.17
------------------------------------------------------------------------
Family 21 Pancreatectomy
------------------------------------------------------------------------
48020............................ 15.70
48100............................ 12.23
48120............................ 15.85
48140............................ 22.94
48145............................ 24.02
48146............................ 26.40
48148............................ 17.34
48150............................ 48.00
48152............................ 43.75
48153............................ 47.89
48154............................ 44.10
48155............................ 24.64
48180............................ 24.72
48500............................ 15.28
48510............................ 14.31
48520............................ 15.59
48540............................ 19.72
48545............................ 18.18
48547............................ 25.83
------------------------------------------------------------------------
Family 22 Laparoscopy
------------------------------------------------------------------------
The RUC recommended no changes to the following codes based on lack of
compelling evidence: 43651, 43652, 44200, 44970, 47562, 47563, 47564,
47570, 49320, 49650, and 49651.
------------------------------------------------------------------------
[[Page 31054]]
The RUC also recommended that the following codes be referred to
the CPT Editorial Panel for review and clarification: 36533, 36534,
36535, 49495, and 49496.
HCFA Proposal:
The ACS conducted full surveys of 32 codes, and we agreed with the
RUC analysis for most of the 32 codes. For the other codes the ACS did
minisurveys that included pre-, intra-, and postservice times as well
as the number and type of postservice visits. These minisurveys did not
include an estimate of the relative work for the procedure. For this
reason, the RUC used an extrapolation methodology to arrive at its work
RVU recommendations for all codes that did not have a full RUC survey.
To make appropriate extrapolations, the RUC divided all of the general
surgery codes into families of related procedures. At least one code in
each family was fully surveyed. After the RUC recommended work RVUs for
each surveyed code, it applied the percent change for that code to all
of the other codes in the family. When more than one code was fully
surveyed within a family of services, the RUC extrapolated the
percentage from the fully surveyed code that would produce the least
increase in work RVUs.
The validity of this extrapolation methodology relies on at least
two things--first, that the relative work values of all codes in the
family were correct before the extrapolation (or else the extrapolation
perpetuates and magnifies any pre-existing anomalies), and second, that
the relative misvaluation of each code in a family is similar.
We did an analysis of all the families of codes in the general
surgery group to determine whether the relative valuations in the 2001
physician fee schedule contained any anomalies. If any anomalies
existed, we reviewed the RUC recommendations to determine whether the
anomalies were addressed by the RUC recommendations. If the anomalies
were not corrected, we took steps to correct them.
We also analyzed all of the recommended values for general surgery
to ensure that the percentage changes for each family were appropriate.
To determine if the extrapolation for each family was correct, we
compared each extrapolated code to codes in other families, and to
codes in other specialties. We compared extrapolated codes to codes
whose current or RUC recommended work RVUs (from the 5-year-review)
were similar to the extrapolated code. We then compared the preservice,
intraservice, and postservice physician times as well as the number of
postoperative visits. In addition, we generally determined whether the
survey vignette was typical for the procedure. The following is an
example of our review of the general surgery codes. Code 35132 (Direct
repair of aneurysm, false aneurysm, or excision (partial or total) and
graft insertion, with or without patch graft; for ruptured aneurysm,
iliac artery (common, internal, external) (30.00 work RVUs) with a
preservice time of 67 minutes, intraservice time of 180 minutes, seven
hospital visits, and three office visits is similar to codes 47712
(Excision of bile duct tumor, with or without primary repair of bile
duct; intrahepatic) (30.24 work RVUs) with a preservice time of 75
minutes, intraservice time of 210 minutes, one intensive care unit
visit, nine hospital visits, and three office visits and 43638
(Gastrectomy, partial, proximal, thoracic or abdominal approach and
esophagogastrostomy with vagotomy) (29.00 work RVUs ) with a preservice
time of 75 minutes, intraservice time of 210 minutes, 10 hospital
visits, and 4 office visits. A review of these codes demonstrates the
similarity in preservice and intraservice time and the proposed RVUs
maintain relativity across surgical specialties.
Upon completion of this analysis, we propose to accept the RUC
recommendations for the following families of services:
Family 1A and 1B Thyroid and Endocrine.
Family 3 Lymph Nodes and Lymphatic Channels--Incision/Excision.
Family 4 Intestines--Excision/Incision.
Family 5 Intestines--External Fistulization.
Family 9 Anus/Rectum--10-day global period.
Family 10 Anus/Rectum--Repair.
Family 11 Hernia.
Family 12 Stomach--Gastrectomy/Vagotomy.
Family 13 Stomach--Incision/Excision/Repair.
Family 14A and C Abdomen, Peritoneum, Omentum.
Family 15 Appendectomy.
Family 16 Rectum-Proctectomy/Excision.
Family 17 Biliary Tract.
Family 18 Esophagus--Repair/Reconstruction.
Family 19 Liver.
Family 20 Pancreas/Spleen--Incision/Excision/Repair.
Family 21 Pancreatectomy.
Family 22 Laparoscopy.
For the above families, adopting the RUC-recommended RVUs maintains
relativity of the codes based upon a comparison of the codes to
procedures in other families and within the family.
For other families of services, the extrapolation methodology
inappropriately values codes or does not address current rank-order
anomalies. Application of the percentage increases derived from the
RUC's extrapolation methodology would only exacerbate any current rank-
order anomalies within families. Below, we have outlined, for each
family of services, our proposed work RVUs to rectify these problems.
Family 2 Lymphadenectomy
The RUC recommended an increase in work RVUs for the fully surveyed
code 38745 (Axillary lymphadenectomy; complete) from 8.84 to 11.0 RVUs
based on comparisons with codes 60210 (Partial thyroid lobectomy,
unilateral, with or without isthmusectomy), and 32100 (Thoracotomy,
major with exploration and biopsy). We disagree. Although codes 38745
and 60210 are performed in the outpatient setting and 32100 is not,
code 38745 requires more postoperative wound care. Additionally, the
RUC compared 38745 to the pre-5-year review value of 32100.
Subsequently the RUC reviewed code 32100 for the 5-year review and is
recommending an RVU increase to 15.24 RVUs. Because the intraservice
times for codes 38745 and 32100 are identical and 38745 requires more
postoperative wound care, a clear rank order anomaly would exist if
38745 was valued at 11.00 work RVUs and 32100 was valued at 15.24 work
RVUs. Therefore, we are assigning the median survey RVUs of 13.00 to
code 38745. We would also note that the survey RVU spread from the 25th
percentile to the 75th percentile ranged from 12.15 to 14.29 RVUs,
which is relatively small. An RVU of 13.00 places code 38745 in the
correct rank order to the comparison codes. To maintain relativity
within this family, we are extrapolating the 47 percent increase in
work RVUs of code 38745 to codes 38740 (Axillary lymphadenectomy;
superficial) and 38760 (Inguinofemoral lymphadenectomy, superficial,
including Cloquets node (separate procedure)) for proposed work RVUs of
10.02 and 12.94, respectively. However, code 38765 (Inguinofemoral
lymphadenectomy, superficial, in continuity with pelvic
lymphadenectomy, including external iliac, hypogastric, and obturator
nodes (separate procedure)) represents a rank-order anomaly as it is
currently valued too high relative to the other codes in the family.
Therefore, we are accepting
[[Page 31055]]
the RUC recommendation for code 38765 of 19.98 work RVUs.
Family 6 Colectomy
The RUC recommended no change in the work RVUs for this family of
codes based on lack of compelling evidence for changing the RVUs of the
fully surveyed code 44140 (Partial colectomy). Moreover, the
intraservice time for code 44140 had not changed since the last 5-year
review. Additionally, the RUC compared code 44140 to code 32480
(Removal of lung, other than total pneumonectomy; single lobe
(lobectomy)) and code 50230 (Nephrectomy, including partial
ureterectomy, any approach including rib resection; radical, with
regional lymphadenectomy and/or vena caval thrombectomy) that have
similar work RVUs to 44140 and were believed to be longer, more intense
procedures with more postoperative care. We disagree with this
recommendation. If the RVUs for procedures in this family are not
changed, the procedures will be significantly undervalued compared to
other general surgery codes (Family 5 and Family 7) and vascular
surgery codes. As an example, we note that the RUC-recommended work RVU
for code 44153 Colectomy, total, abdominal, without proctectomy; with
rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir
(S or J), with or without loop, will significantly undervalue this code
compared to code 45113, Proctectomy, partial, with rectal mucosectomy,
ileoanal anastomosis, creation of ileal reservoir (S or J), with our
without loop ileostomy, thus creating a rank-order anomaly.
We compared code 44140 to code 32480 for which the RUC is
recommending a work RVU increase to 23.75. These procedures have
similar intraservice times, and the postoperative visits show that
although the initial care required for code 32480 is more intense, the
length of stay for code 44140 is frequently longer. We also compared
code 44140 to codes 37617, Ligation, major artery (eg post-traumatic,
rupture); abdomen, and 35221, Repair blood vessel, direct; intra-
abdominal. Code 37617, for which the RUC recommended work RVUs of
22.06, is an emergency operation with a slightly shorter intraservice
time and shorter hospital stay. Code 35221, which has RUC-recommended
work RVUs of 24.39, is also an emergency operation with an intraservice
time and length of stay identical to code 44140. Based on these
comparisons, we believe that the survey's 25th percentile work RVUs of
21.00 are appropriate and correctly rank code 44140 to the comparison
procedures. This increase is 14 percent greater than the current work
RVUs and, with the exception of the two codes discussed below, applying
this 14 percent increase to the other codes in this family will place
them in proper relationship to other comparable procedures.
Family 6 contains two current rank-order anomalies: code 44151,
Colectomy, total, abdominal, without proctectomy; with continent
ileostomy, has lower work RVUs than code 44150, Colectomy, total,
abdominal, without proctectomy; with ileostomy or ileoproctostomy, and
44156, Colectomy, total, abdominal, with proctectomy; with continent
ileostomy, has lower work RVUs than code 44155, Colectomy, total,
abdominal, with proctectomy; with ileostomy. Code 44151 is identical to
code 44150, and code 44156 is identical to code 44155, except that
codes 44151 and 44156 involve the creation of a ``continent ileostomy''
instead of an ``ileostomy or ileoproctostomy.'' The work of creating a
``continent ileostomy'' is greater than the work of creating an
``ileostomy or ileoproctostomy.'' To correct this rank-order anomaly,
we applied the 14 percent increase discussed above to codes 44150 and
44155. Next, we determined the proper incremental increase in work for
creation of a ``continent ileostomy'' by looking to codes 44310,
Ileostomy or jejunostomy, non-tube (separate procedure), and 44316,
Continent Ileostomy (Kock procedure) (separate procedure), because the
work RVUs of 44316 are the same as the work RVUs of 44310 with the
addition of creating a continent ileostomy. We subtracted the RUC-
recommended work RVUs of 15.95 for code 44310 from the RUC-recommended
work RVUs of 21.09 for code 44316 and divided by 50 percent (50 percent
approximates the intraservice portion of the extra work). This resulted
in work RVUs of 2.57 that we increased by 14 percent to yield work RVUs
of 2.93. We then added 2.93 work RVUs to the RVUs for codes 44150 and
44155 to yield proposed work RVUs of 26.88 for code 44151 and 30.79 for
code 44156.
In summary, we propose the following work RVUs for the codes in
this family:
------------------------------------------------------------------------
Code Work RVUs
------------------------------------------------------------------------
44140...................................................... 21.00
44143...................................................... 22.99
44144...................................................... 21.53
44145...................................................... 26.42
44146...................................................... 27.54
44150...................................................... 23.95
44151...................................................... 26.88
44152...................................................... 27.83
44153...................................................... 30.59
44155...................................................... 27.86
44156...................................................... 30.79
------------------------------------------------------------------------
With these assigned work RVUs, we believe that Family 6 is ranked
appropriately in relation to other general and vascular surgery codes.
Family 7 Intestines--Repair
The RUC recommended an increase of 14 percent for all work RVUs in
this family based on a recommended increase in a fully surveyed code
44604 (Suture of large intestine (colorrhaphy) for perforated ulcer,
diverticulum, wound, injury or rupture (single or multiple
perforations); without colostomy) from 14.28 work RVUs to 16.03 work
RVUs.
We agree with the increase in work RVUs for code 44604 but note
that there are several rank-order anomalies currently in this family of
codes that would be exacerbated by an across-the-board increase in work
RVUs. Therefore, we propose to correct the rank-order anomalies as
follows:
We propose 16.03 work RVUs for 44602 (Suture of small intestine
(enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or
rupture; single perforation). The work RVUs for code 44602 are
identical to the work RVUs for code 44604 because they describe the
same procedure except code 44604 is for the large intestine.
We propose work RVUs of 19.53 for code 44605 (Suture of large
intestine (colorrhaphy) for perforated ulcer, diverticulum, wound,
injury or rupture (single or multiple perforations); with colostomy).
The work RVUs for code 44605 are identical to the work RVUs for code
44604 except that code 44605 includes creating a colostomy with the
attendant increase in postoperative wound care. The intraservice work
of creating a colostomy is captured by subtracting the work RVUs for
code 44140 from code 44143, which leaves 1.99 RVUs. In addition, there
is one extra postoperative visit required for code 44605 that we
believe is equivalent to code 99233 that has 1.51. work RVUs.
Therefore, we added 1.99 and 1.51 work RVUs to the work RVUs for code
44604 to arrive at 19.53 work RVUs for code 44605.
We propose 18.66 work RVUs for code 44603 (Suture of small
intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound,
injury or rupture; multiple perforations). The additional work required
for code 44603 as compared to code 44602 is similar to the additional
work required for code 44605
[[Page 31056]]
as compared to code 44604 except, since there is no actual colostomy,
the additional postoperative visit is comparable to code 99231 with
0.64 work RVUs. Therefore, we added work RVUs of 1.99 and 0.64 to the
work RVUs of code 44602 to arrive at 18.66 work RVUs for code 44603.
The current work RVUs for codes 44640 (Closure of intestinal
cutaneous fistula); 44650 (Closure of enteroenteric or enterocolic
fistula); 44660 (Closure of enterovesical fistula; without intestinal
or bladder resection); and 44661 (Closure of enterovesical fistula;
with bowel and/or bladder resection) are rank-order anomalies as they
are undervalued compared to code 44604. However, relativity among codes
44640, 44650, 44660, and 44661 is appropriate. To correct the
anomalies, we compared codes 44650 to 50525 (Closure of nephrovisceral
fistula (eg renocolic) including visceral repair; abdominal approach),
which involves similar intraoperative and postoperative work. The
intraoperative work for code 50525 is greater than that of code 44650
because code 50525 involves visceral repair but the postoperative work
for code 44650 is greater than the postoperative work for code 50525
because the fistula is enteroenteric or enterocolic as opposed to
renovisceral (that is, renocolic). Therefore, we propose to assign
22.27 work RVUs to code 44650 and, to keep the current relativity with
the other codes, we propose 21.65 work RVUs for code 44640, 21.36 work
RVUs for code 44660, and 24.81 work RVUs for code 44661. We propose to
accept the RUC recommendations for the remaining codes (44615, 44620,
44625, 44626, 44680, 44700, and 44850).
Family 8 Anus/Rectum--Hemorrhoids/Fistula
The RUC extrapolated a 14 percent decrease in work RVUs to all
codes in this family based upon a decrease in work RVUs for the fully
surveyed code 46262, Hemorrhoidectomy, internal and external, complex
or extensive; with fistulectomy, with or without fissurectomy. We agree
with the RUC recommendation for the surveyed code, but disagree with
the extrapolation to the anal fistula repair codes and the anal abscess
treatment codes. The surveyed intraoperative time for code 46262 is not
consistent with the surveyed intraoperative times for many of the other
codes in the family. Moreover, the work RVUs for many of the codes
subject to the minisurveys are significantly less than for code 46262
and are not comparable. Therefore, we propose to maintain the current
RVUs for codes 46270, 46275, 46280, 46288, 45000, 45020, 45100, 45108,
46040, 46045, and 46060. We agree with the RUC recommendations and
propose to decrease the work RVUs for other codes in this family of
codes (46250, 46255, 46257, 46258, 46260, 46261, 46262, 46934, 46936,
46945, and 46946).
Family 14B Abdomen, Peritoneum, Omentum
The RUC recommended an increase for the fully-surveyed code 49020,
(Drainage of peritoneal abscess or localized peritonitis, exclusive of
appendiceal abscess; open,) from 16.79 work RVUs to 20.73 work RVUs,
the 25th percentile of surveyed work RVUs, based on a comparison to
code 61312 (Craniectomy or craniotomy for evacuation of hematoma,
supratentorial; extradural or subdural). We disagree and propose the
surveyed median work RVUs of 22.84. We compared code 49020 to code
35151 (Direct repair of aneurysm, false aneurysm, or excision (partial
or total) and graft insertion, with or without patch graft; for
aneurysm, false aneurysm and associated occlusive disease, popliteal
artery), 48000 (Placement of drains, peripancreatic, for acute
pancreatitis), and code 48140 (Pancreatectomy, distal subtotal, with
our without splenectomy; without pancreaticojejunostomy). Code 48000
involves sicker patients but the intraoperative time (120 minutes) and
postoperative visits (10-day length of stay for code 48000 with two
critical care visits versus an 11-day length of stay for code 49020
with one critical care visit) are similar, and code 48000 has RUC-
recommended work RVUs of 28.07. Code 48140, with RUC-recommended work
RVUs of 22.94, has a longer intraoperative time (150 minutes) with a
shorter length of stay (9 days with one critical care visit) and
involves less sick patients. Code 35151, with RUC-recommended work RVUs
of 22.64, involves patients not nearly as ill as patients for whom code
49020 is reported, has a surveyed intraoperative time of 150 minutes,
and a 5-day length of stay with no critical care visits. Therefore, we
propose the median surveyed work RVUs of 22.84 for code 49020. Since
the current relativity within this family is correct, we propose to
extrapolate this increase of 36 percent to the other codes in this
family and value the work as follows: 49040 (13.52), 49060 (15.86), and
49085 (12.14).
Comment: The American Society of Colon and Rectal Surgeons
collaborated with the ACS and submitted 12 codes for review that they
believe to be undervalued. They also expressed support for the
methodology proposed by ACS to value services. The specific codes
referenced were: 44130, 44144, 44147, 44151, 44156, 44394, 45111,
45113, 45337, 45339, 45910, and 46258.
RUC Recommendation:
The RUC recommended increasing the work RVUs for the following
codes: 44130 (14.49), 45113 (30.58), and 45910 (2.80) to retain current
rank-order and relativity within the grouping of services. However, for
code 46258, the RUC recommended decreasing the work RVUs to 5.73 to
retain the current rank-order and relativity within these services.
For codes 44147, 44394, 45111, 45337, 45339, 44144, 44151, and
44156, the RUC did not receive compelling evidence to suggest an
increase was needed in the work RVUs; therefore, the RUC recommended
that the current work RVUs for these codes be maintained.
HCFA Proposal: We propose to accept all but one of the RUC
recommendations for the surgical codes submitted by the American
Society of Colon and Rectal Surgeons. For code 44147, Colectomy,
partial; abdominal and transanal approach, we are proposing to increase
the work RVUs by 14 percent to 20.71. This is similar to the increase
applied to ACS family 6 and will prevent a rank-order anomaly.
Comment: The American Academy of Otolaryngology-Head and Neck
Surgery submitted codes, on behalf of the American Otological Society
and the American Academy of Facial Plastic and Reconstructive Surgery,
that they believe to be undervalued, along with suggested new work RVUs
for each service. However, subsequent to the submission of their
comments, the specialty society chose not to pursue revaluing of the
following codes: (69450, 69436, 69440, 69631, 69205, 69801, 69633,
69501, 69632, 69905, 69666, 69650, 69806, 69667, 69720, 69641, 69550,
69636, 69637, 69643, 69140, 69505, 69635, 69502, 69645, 69511, 69601,
69602, 69642, 69603, 69644, 69910, 69660, 69604, 69646, 69662, 69661,
69930, 69145, 69676, 69310, 69620, 69805, 69670, 69700, 69802, 69320,
69530, 69820, 68711, 69840, 69540, 69421, 69552, 69150, 69915, 69605,
69300, 69000, 69005, 69020, 69711, 69100, 69105, 69110, 69120, 69140,
69145, 691500, 69155, 69200, 69205, 69210, 69220, 69222, 69300, 69310,
69320, 69400, 69401, 69405, 69410, 69420, 69421, 69424, 69433, 69436,
69535, 69554, 69610, 69725, 69740, 69745, 69950, 69955, 69960, 69970).
[[Page 31057]]
RUC Recommendation: For codes 69990, 11642, 13131, and 13132, the
RUC recommends no change to the current RVUs for these services, as
compelling evidence was not provided to demonstrate the need for an
increase.
HCFA Proposal: We have reviewed and propose to accept all of the
RUC recommendations for the surgical codes submitted by the American
Academy of Otolaryngology-Head and Neck Surgery.
3. Thoracic Surgery
Comment: In their comments, the Society of Thoracic Surgeons (STS)
indicated that there have been major changes in the practice of
thoracic surgery since the initial development of the physician fee
schedule. These major changes in surgical techniques, along with
changes in the typical patient, have had an impact on physician work.
Time and intensity of a number of procedures, including the reference
procedures used by STS, have been affected.
The STS grouped codes into three categories: general thoracic
surgery, adult cardiac surgery, and congenital thoracic surgery. These
three categories were grouped into 23 families of codes. Each family
had an anchor code that received a full RUC survey. Each of the
remaining codes in a family received a minisurvey. The minisurvey
collected information on time and the number of postoperative visits.
The minisurvey also asked respondents to estimate work RVUs for the
procedure based on the reference service for the family of codes.
The RUC had a number of concerns with the STS approach. They are as
follows: (1) The RUC concluded that STS inappropriately had the same
survey respondents review and estimate both misvalued services and
reference services. (2) In many instances, the respondents valued the
code under review relative to their perception of what the reference
code value should be, not the current value of the reference code. (3)
The STS also used too many minisurveys and too few full surveys. (4)
Within a family of codes, the STS inappropriately mixed codes with
different global periods.
To overcome these methodological problems, the RUC first reviewed
the reference service that was used for each family, and the resulting
value was compared to the codes in each family. For the adult cardiac
surgery codes, the RUC developed a building-block methodology to
validate the survey results. For the congenital thoracic codes,
previous RUC reviews of the codes were used to determine how the work
has changed since the last 5-year review. In addition, for the
pediatric thoracic codes, the specialty's society's presenter offered
additional information demonstrating that the patient population has
changed, (for example, more neonates) leading to a higher intensity of
work.
Additionally, The STS subsequently chose not to pursue review of
code 33207 under the 5-year review.
RUC Recommendations: The RUC reviewed 89 thoracic surgery codes. Of
this total, the RUC recommended increases for 44 codes, no changes for
43 codes, and decreases for 2 codes. The recommendations by family are
as follows:
Family 1: The RUC generally found that the STS had not furnished
compelling evidence or that the STS inappropriately compared codes with
a zero global period to codes with a 90-day global period. 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 code 32220 (24.00) and code 32320 (24.00), based on the
median surveyed work RVUs which would place these codes in proper rank
order.
Family 2: The RUC recommended increases for code 32440 (25.00)
based on the median survey value, and code 32480 (23.75) based on the
value of 43415. The RUC also recommended increases in work RVUs for
codes 32100 (15.24) and 32110 (23.00) based on a comparison to code
58150. These values place all these codes in proper rank order.
Family 3: The RUC recommended increases in codes 32482 (25.00) and
32500 (22.00), based on the STS surveyed median work RVUs for each
code, which would create the proper rank order within the family of
codes.
Family 4: The RUC recommended no increase for code 32655 because
the STS had not furnished compelling evidence for an increase in work.
The RUC recommended increases for codes 31600 (7.18) and 32500 (22.00)
based on survey data, a sicker patient population, and, in the case of
31600, comparison to 35474.
Family 5: The RUC recommended increases for codes 38746 (4.89)
based on the work RVU for 38747, but recommended no increases for codes
39010, 39220 or 39400 due to lack of compelling evidence or
inappropriate comparisons to codes with 90-day global periods.
Family 6: The RUC agreed with the STS analysis of work for codes
43107 (40.00) and 43112 (43.50) and stated that using the survey median
for each code correctly rank ordered these codes in the family of
esophagectomy codes.
Family 7: The RUC recommended an increase for code 43117 (40.00)
after comparing it to the reference service code 43361 which had
similar data. The RUC also recommended an increase for code 43122
(40.00) based on the survey median of 40.00 work RVUs which correctly
rank ordered this code in the family of esophagectomy codes.
Family 8: The RUC recommended no increase for codes 31625 or 31645
because the STS did not furnish compelling evidence for an increase in
work.
Family 9: The RUC recommended increases for the following 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 the following 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. The RUC recommended no increases for codes 33425 or
33468 because the building-block approach did not support the STS's
requested increase.
Family 11: The RUC recommended increases for the following 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 recommended decreases for codes 33514 (32.75)
and 33516 (35.00). These were the values recommended by the STS and
validated through the building-block approach.
Family 12: The RUC recommended no increases for the following add-
on codes: 33517, 33518, 33519, 33521, 33522, 33523, and 33530, because
it believes that 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 the
following 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. The RUC recommended no increase
for code 33530 because it is an add-on code and was inappropriately
surveyed as a 90-day global surgical procedure.
Family 14: The RUC recommended increases in work RVUs in the
following 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. The RUC recommended no increase for code
33945 because the building-block approach did not
[[Page 31058]]
support the higher value requested by the STS.
Family 15: The RUC recommended no increases in work RVUs for the
following codes: 33750, 33820, and 33840, due to 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. The RUC recommended no increase in code 33641 as it did
not find any compelling evidence to warrant a change in the work RVUs.
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 has changed, and the minisurvey did not provide compelling
evidence to justify a change in the work RVUs. 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 5 years
ago.
Family 18: The RUC recommended increases in the following 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 the
following codes: 33611 (34.00), 33612 (35.00), 33694 (34.00) and 33697
(36.00). The RUC compared the intraservice time of code 33611 to the
family anchor code of 33694 and recommended 34.00 work RVUs to maintain
proper rank order in the family. The RUC compared code 33612 to code
33611 and agreed code 33612 was equivalent to 33611 plus 1 additional
work RVU. The RUC compared code 33694 to 33412 and concluded that all
measures of physician work were greater for 33694. The RUC compared
code 33697 to 33694 and recommended 36.00 work RVUs to maintain rank
order. The RUC recommended no increase for 33767 because there was no
compelling evidence for a change in the work RVUs.
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.
Based on information supplied to the RUC, the RUC did not recommend
a change in RVUs for codes 32520, 33917, 31622, and 32657. For codes
32095, 33410 and 32491, the RUC indicated that it had recently reviewed
these codes, and thus it recommended no change. The RUC recommended
that codes 33875, 33877, 43107, and 43112 be referred to the CPT
Editorial Panel.
HCFA Proposal:
We validated the RUC recommendations by comparing the thoracic
surgery codes to vascular surgery and general surgery codes and propose
to use the RUC-recommended work RVUs for the thoracic codes based on
our own analysis. The following is an example of our review of the
thoracic surgery codes. We compared code 32440 (Removal of lung, total
pneumonectomy) (25.00 work RVUs) with a preservice time of 90 minutes,
intraservice time of 160 minutes, one intensive care unit visit, six
hospital visits, and three office visits with the following surgical
codes in other surgical specialties: code 34151 (Embolectomy or
thrombectomy, with or without catheter; renal, celiac, mesentery,
aortoiliac artery, by abdominal incision) (25.00 work RVUs) with a
preservice time of 75 minutes, intraservice time of 150 minutes, seven
hospital visits, and three office visits and code 44150 (Colectomy,
total, abdominal, without proctectomy; with ileostomy or
ileoproctostomy) (23.95 work RVUs) with a preservice time of 63
minutes, intraservice time of 200 minutes, eight hospital visits, and
three office visits. A review of these codes demonstrates the
similarity in preservice time and intraservice time and the proposed
RVUs maintains relativity across surgical specialties.
4. Orthopedic Surgery
Comment: The American Academy of Orthopaedic Surgeons forwarded 42
codes for review. It indicated that these codes were undervalued when
compared to their respective reference codes.
RUC Recommendation:
The RUC recommended increasing the work RVUs for the following
codes: 29883 (11.05) because this service consists of two procedures;
29889 (16.00) based on increase in post and intraservice work; 29450
(2.08) based on the increased intraservice time for manipulating the
foot of the patient; code 28299 (9.18) which is of value equal to the
reference code, with the understanding that the code be sent to CPT
Editorial Panel to better define the code; code 28705 (18.80), which
more accurately reflects the work of the two distinct services of this
procedure (ankle fusion and triple arthrodesis); code 23472 (21.10) to
correct a rank-order anomaly; code 26562 (15.00) to correct a rank-
order anomaly; code 20245 (8.50) to correct a rank-order anomaly; code
27075 (35.00) noting that this is a major operation and there is
increased intraservice time with respect to the reference code; code
27077 (40.00) noting that this a major operation and there is increased
intraservice time with respect to the reference code; 27284 (23.45)
because this is the value for code 27227 that has identical pre-,
intra-, and postservice times; code 27286 (23.45) to avoid creating a
rank-order anomaly due to the recommended work RVUs increase of code
27284; code 27822 (11.00) to correct an existing rank-order anomaly;
code 27823 (13.00) to avoid creating a rank-order anomaly caused by
increasing code 27822; code 28445 (15.62) to correct a rank-order
anomaly and appropriately reflect the work involved; code 27724 (18.20)
to reflect the work for obtaining a graft that was not included in the
last 5-year review.
The RUC believed that the commenter provided no compelling evidence
to revise the work RVUs for codes 27280, 27282, 23585, 23615, 23630,
23680, 24545, 27216, 27217, 27218, 27226, 27236, 27513, 27536, 27828,
23485, 24435, 27472, 28322, and 28420. Therefore, the RUC recommended
the current work RVUs be maintained for these codes.
The RUC referred the following codes to the CPT Editorial Panel for
clarification: 23076, 24076, 25076, 27048, 27328, 27619, and 20205,
because these codes are being reported incorrectly.
HCFA Proposal:
[[Page 31059]]
We propose to accept all but one of the of the RUC recommendations
for the orthopedic surgery codes. For code 20245, (Biopsy, bone,
excisional; deep (eg, humerus, ischium, femur), the RUC recommended an
increase from 3.95 work RVUs to 8.5 work RVUs and compared code 20245
to codes 27635 (Excision or curettage of bone cyst or benign tumor,
tibia or fibula), and 27607 (Incision (eg, osteomyelitis or bone
abscess), leg or ankle) (work RVUs of 7.78 and 7.97, respectively),
because it believed the work required for code 20245 was similar to the
work required for these codes. The survey for code 20245 compared the
code to code 27635. The intraservice times were similar (90 versus 85
minutes) and the amount of postservice was similar (169 versus 163
minutes). However, the survey median work RVUs were 13 and the 25th
percentile RVUs were 8.5. The RUC recommended the 25th percentile RVUs
because the RVUs were reasonably close to the RVUs for code 27635. We
agree that the current work RVUs are a rank-order anomaly with code
20240 (Biopsy, bone, excisional; superficial (eg, ilium, sternum,
spinous process, ribs, trochanter or femur)); however, we disagree with
the RUC recommendation. The intraservice work of a deep excisional bone
biopsy is similar to the work of excising a bone cyst or benign tumor
from the tibia and fibula (code 27635). This is reflected in the
similarity in their pre-, intra-, and postservice times. Moreover, the
vignette used for code 20245 was atypical in that it involved an
ischial lesion, whereas the code is also to be reported for lesions of
the humerus and femur. Lesions of the humerus and femur require less
dissection and would be more comparable to lesions of the tibia and
fibula. Moreover, code 27635 requires complete removal of a known
lesion, whereas code 20245 is only an excisional biopsy. Additionally,
we are concerned about the spread of work RVUs in the work survey (25th
percentile was 8.5 RVUs and 50th percentile was 13.0 work RVUs) and
lack of consistency with the time data from the survey. We do not
believe there is compelling evidence that the work of code 20245 is
greater than the work of code 27635 and are therefore proposing to
assign 7.78 work RVUs to code 20245, which is identical to work RVUs
for the reference service code 27635.
5. Ophthalmology
Comment: The American Academy of Ophthalmology submitted comments
requesting nine codes be reviewed, including one code for evaluation of
the global period and not the work RVU. The specialty society
subsequently chose not to pursue review of codes 66170, 66172, and
67108.
RUC Recommendation:
The RUC agreed with the request from the specialty society to
change the global period from 90 days to 10 days for code 65855 (Laser
surgery of eye) and also reduced the work RVUs to 3.85 to account for
this reduction in the global period. The RUC noted that code 67218
includes two procedures, and the specialty society indicated that this
was not reflected in the original valuation. To correct this error, a
building-block approach was used to arrive at new RVUs more reflective
of the work of both procedures. The RUC recommended work RVUs of 18.53
for this service. For code 92018, the RUC acknowledged that the
preservice work of this service was greater than the standard office
procedure because of the need for anesthesia. While concerned about the
reliability of the data provided, the RUC recommended that the work
RVUs be increased to 2.50, as it suggested during the first 5-year
review, with the understanding that the code would be sent to the CPT
Editorial Panel for clarification.
For codes 66180, 66986, 67028, and 67904, the RUC believed that the
commenters provided no compelling evidence to justify an increase in
the work RVUs; therefore, the RUC recommended maintaining the current
value for this code.
HCFA Proposal:
We have reviewed and propose to accept all of the RUC
recommendations for the ophthalmology codes.
6. Urology
Comment: The American Urological Association presented four codes
for review: 50230, 51595, 51596, and 38780. They believed that the work
RVUs for these codes do not account for all the in-hospital and office-
based postoperative care.
RUC Recommendation:
The RUC questioned the arguments for an increase in RVUs, noting
that there was no compelling evidence presented for recommending an
increase for three of these codes (51595, 51596 and 38780). However,
the RUC noted that the code descriptor for code 50230 includes the term
``and/or vena caval thrombectomy'' which impacts the work RVU. The RUC
agreed to refer this code back to the CPT Editorial Panel to separate
these two distinct services so each may be reported and valued
appropriately.
HCFA Proposal:
We have reviewed and propose to accept all of the RUC
recommendations for the urology codes.
7. Obstetrics/Gynecology
a. Specialty Comments
Comment: The American College of Obstetrics and Gynecology (ACOG)
referenced 35 codes in their written comments submitted to us. The
specialty society chose not to pursue the review of work RVUs for code
57555, as well as the work RVUs for codes 59150 and 59151.
RUC recommendation:
The RUC recommended increases in the RVUs for the following codes:
38572 (16.59) that would align the code relative to the work of other
laparoscopic codes; 56515 (2.76), which was not the value requested by
the specialty group but was the value assigned to code 46924, which has
comparable work and intraservice time; 56740 (4.57) based on a modified
building-block approach, which was similar to ACOG's approach; 57100
(1.20) as presented by the specialty society; 58152 (20.60) in
recognition that the current work RVUs are less than the RVUs for code
58150 performed alone even though 58152 combines the work of codes
58150 and 58840; 58260 (12.98) to reflect work of additional office
visits included in the procedure; 58262 (14.77) to accurately reflect
the work of its component procedures; 58263 (16.06), 58275 (15.76),
58270 (14.26) and 58280 (17.01) to maintain relativity within family of
hysterectomy codes; 58267 (17.04) because the procedure is currently
undervalued since it encompasses three separate components; 58285
(22.26), which was lower than requested by the specialty group, but
which the RUC believed was more reflective of the work for the
procedure; 58600 (5.60) based on similarity of this procedure to code
58670; 58605 (5.00) to reflect the slightly lower pre-, intra-, and
post-times for this code as compared to 58670; 58611 (1.45) to
appropriately reflect the increase in preservice work; 58700 (12.05)
reflecting the higher technical skill associated with this procedure
(removing only fallopian tube versus ovary and fallopian tube); 58740
(14.00) to reflect increase in intra-service time and postoperative
work; 58825 (10.98) which aligns the work value with other codes with
similar work; 58920 (11.36) to correct a rank-order anomaly; 58950
(16.93) which combines both codes 58720 and 49255 and applies the
multiple procedure rule; 58951 (22.38) based on the similarity of work
to 58285 which has the same
[[Page 31060]]
recommended value; 59812 (4.01) based on the similarity of work to code
59820; 59870 (6.01) based on increased physician work and postoperative
time.
The RUC indicated that the commenter provided no compelling
evidence to support an increase in the work RVUs for codes 38571,
57130, 57292, 57307, 57505, 58323, 58400, and 58805.
For code 58820, the RUC indicated that this service had recently
been reviewed by the RUC and, therefore, the current work RVUs should
be maintained.
HCFA Proposal:
We have reviewed and propose to accept all of the RUC
recommendations for the obstetrics/gynecology codes.
b. Other Concerns
We have been alerted to concerns that certain female-specific
procedures may be undervalued. Our staff has reviewed the work RVUs
associated with a number of female-specific procedures, including major
and minor surgical procedures as well as several laparoscopic
procedures and has determined that, for the most part, the RVUs
assigned seem reasonable and consistent with the time, intensity, and
postoperative care involved with the procedures. However, there were
several codes that seemed to be inappropriately valued as compared to
other similar procedures. These procedures are: code 56515 (Destruction
of vulvar lesions, extensive); code 57100 (Biopsy of vagina); code
56605 (Biopsy of vulva); code 58100 (Biopsy of endometrium); and code
56810 (Perineoplasty).
We forwarded two of these codes (codes 56515 and 57100) to the RUC
for review under the 5-year refinement process, and the RUC has
recommended an increase in work RVUs for both of these codes.
We have referred the remaining three codes that appear to be
misvalued to the RUC for review, and we anticipate receiving a response
from the RUC that we can consider in the November 1, 2001 final rule.
8. Gastroenterology
Comment: The American Society for Gastrointestinal Endoscopy
(ASGE), American College of Gastroenterology (ACG), and the American
Gastrointestinal Association (AGA) provided comments describing
gastrointestinal services that they believed to be misvalued. Their
comments focused on the identification of specific services whose work
RVUs they believe are too low in comparison to other gastroenterology
services when comparing time and intensity of the procedures. They also
expressed concern that the work RVUs for all gastroenterology
procedures involving conscious sedation are substantially undervalued
and need to be increased because of the added requirements associated
with conscious sedation.
RUC Recommendation:
With regard to conscious sedation, the RUC was concerned about--(1)
The need to break out different levels of physician work for conscious
sedation, and (2) many gastroenterology codes have been previously
valued with conscious sedation included and some codes were not valued
with conscious sedation included. Therefore, the RUC agreed to create a
joint RUC and CPT workgroup to review and define the issues related to
conscious sedation. Based upon information presented by the specialty
at the February 2001 RUC meeting, the RUC agreed that elements of
conscious sedation have changed over the past 5 years; however, the RUC
was not able to quantify the change in physician work. While the RUC
did not recommend a specific increase, it did recommend and urge us to
allow separate reporting and payment of conscious sedation codes 99141
and 99142 when conscious sedation is not inherently included as a
component of the physician work of the procedure.
Based on technological advances, increased complexity in procedure,
and changes in patient population the RUC recommended an increase in
work RVUs for the following codes: 43219 (3.18); 43239 (2.87); 43244
(5.05); 43247 (3.59): 43249 (3.35); 43255 (4.82); 43259 (8.59); 43263
(7.29); 43265 (10.02); 43269 (8.21); 44388 (3.70); 44389 (4.26); 44390
(4.81); 44391 (5.18); 44392 (4.81); 44393 (5.00); and 45380 (4.44).
Based on the lack of compelling evidence to increase the work RVUs,
the RUC recommended that the current work RVUs be maintained for the
following codes: 43217, 43228, 43246, 43251, 43258, 44394, 45383,
45384, and 45385.
HCFA Proposal:
The RUC reviewed a selected series of gastrointestinal endoscopy
codes for the 5-year review. These codes included endoscopy of the
esophagus, stomach, duodenum, small intestine, large intestine, stoma,
and biliary tree. The RUC recommended increases in work RVUs for some
of the codes and no change in work for other codes. Unfortunately, the
RUC could not review all of the endoscopy codes in each family and,
therefore, was in the position of having to make recommendations that
would likely cause new rank-order anomalies or exacerbate existing
rank-order anomalies within and among these families. Furthermore,
creation of rank-order anomalies across specialties was also likely.
For example, a bronchoscopic biopsy would be valued significantly less
than a gastrointestinal endoscopic biopsy if the gastrointestinal
endoscopic biopsy was increased in value.
Although we are concerned that some of these endoscopy codes may be
misvalued, we are proposing to keep all work RVUs for gastrointestinal
endoscopy codes unchanged. However, we believe that a comprehensive
review of the work RVUs for all gastrointestinal endoscopy codes is
warranted. Therefore, we are asking the RUC to perform a comprehensive
review of all gastrointestinal endoscopy codes to ensure that all codes
are properly valued, and that no rank-order anomalies within and across
specialties are created or exacerbated. We hope to receive
recommendations from the RUC for these codes in time for the proposed
physician fee schedule regulation in 2002.
Below we discuss our reasons for proposing to reject the
recommended work increases for each code. However, we note that many
new gastrointestinal endoscopy CPT codes were created for use in 2002
and reviewed by the RUC concurrent with the 5-year review.
Recommendations for these new codes were made by comparing them to the
current work RVUs of existing gastrointestinal endoscopy codes, some of
which were reviewed as part of the 5-year review. Therefore, any
increases in work RVUs for codes in the 5-year review will likely
invalidate the work RVUs for many of the new codes reviewed by the RUC.
Furthermore, proposals have been made for even more gastrointestinal
endoscopy CPT codes for CYs 2002 and 2003. We want to ensure that these
new codes are properly reviewed and appropriate work RVUs assigned.
Until a comprehensive review of all gastrointestinal endoscopy codes is
performed we do not believe this is possible.
Code 43219, Esophagoscopy, rigid or flexible; with insertion of
plastic tube or stent:
The RUC recommended an increase in work RVUs from 2.8 to 3.18 based
upon the increased complexity of the condition of patients receiving
these stents. The current work increment between this code and 43200
(1.21 RVUs) has been used extensively by the RUC to make
recommendations for other endoscopic stent placement procedures.
Therefore, in spite of this recommendation, it appears that the RUC and
the specialists who perform
[[Page 31061]]
this procedure agree that the correct increment for stent placement is
1.21 work RVUs. If the work RVUs for code 43219 were accepted, many
other recommendations from the RUC would need to be reevaluated.
Furthermore, it is unclear from the vignette used to value this
procedure whether or not predilation of the esophagus was included in
the work of this code. Currently, code 43226 describes the work of
predilation and may be billed in addition to code 43219. The
incremental work for placing a tracheal stent with predilation (the
difference in work between codes 31622 and 31631) is 1.59 work RVUs.
This is significantly less than the current work increment for
esophageal stent placement with predilation, 1.96 (1.21 + .75).
Additionally, the vignette describes placement of an expandable wire
mesh stent but the code is also used for plastic stents, placement of
which may require less work. We propose maintaining the current RVU for
this code in view of these concerns and the rank-order anomalies that
would be created by accepting the RUC recommendation.
Code 43239 (Upper gastrointestinal endoscopy including esophagus,
stomach, and either the duodenum and/or jejunum as appropriate; with
biopsy, single or multiple):
The RUC recommended an increase in work RVUs from 2.69 to 2.87
based on a larger number of biopsies obtained during a procedure. The
RUC also stated that technological advances allowing for greater
precision and detail in finding abnormalities have increased the need
for this service. The RUC also stated that technological advances have
allowed for more immediacy of results which increases the post service
work in conveying the biopsy information and treatment guidance to the
patient. We would note that the current work increments for all
endoscopic gastrointestinal biopsy codes (described as the base
procedure with ``biopsy, single or multiple'') are 0.3 RVUs. Accepting
the RUC recommendation would increase this increment to 0.48 work RVUs
while keeping all the other biopsy increments at 0.3 work RVUs,
creating a clear rank-order anomaly. Furthermore, this code is used for
``single'' biopsies, and, with the increase in work, these biopsies
would be overvalued. We also do not understand how technological
advances in locating lesions and getting more immediate results
increases the work of the procedure itself. Therefore, we propose
maintaining the current work RVU for this procedure.
Code 43244 (Upper gastrointestinal endoscopy including esophagus,
stomach, and either the duodenum and/or jejunum as appropriate; with
band ligation of esophageal and/or gastric varices) and 43255 (Upper
gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with control of bleeding, any
method):
The RUC recommended an increase in work RVUs for code 43255 from
4.4 to 4.82 work RVUs based on new technology, such as lasers, to
control bleeding. The RUC also states that this new technology
increases the intensity of the procedure. However, the vignette used to
survey code 43255 describes use of cautery to control bleeding. The
work for this code must be appropriate for all methods of controlling
bleeding and the vignette must represent the typical case. The current
work increment for ``control of bleeding, any method'' for
gastrointestinal endoscopic procedures is 2.01 work RVUs. Acceptance of
the RUC recommendation for code 43255 would make this work increment
2.43 RVUs, for upper gastrointestinal endoscopy only, creating a clear
rank-order anomaly.
The RUC recommended an increase in work RVUs for code 43244 from
4.59 to 5.05 RVUs, based on the increased number of bands used to treat
esophageal varices. However, the RUC agreed that the work RVUs for code
43244 were similar to the work RVUs for code 43255. Therefore,
accepting the RUC recommendation for code 43244 and not code 43255
would create a clear rank-order anomaly. We believe that these two
codes should have similar work RVUs. Therefore, we propose to maintain
the current work RVUs for these procedures.
Code 43247 (Upper gastrointestinal endoscopy including esophagus,
stomach, and either the duodenum and/or jejunum as appropriate; with
removal of foreign body):
The RUC recommended an increase in work RVUs for this code from
3.39 to 3.59 work RVUs based on increased complexity of the condition
of patients undergoing this procedure with a concomitant increase in
risk of morbidity. The RUC used a building-block approach to validate
its acceptance of the median work RVUs from the survey. We do not fully
understand the building-block analysis the RUC used but believe it was
invalid. Moreover, the current work increment for ``removal of foreign
body'' for gastrointestinal endoscopy procedures is 1.0 work RVUs.
Acceptance of the RUC recommendation would create a clear rank-order
anomaly. Therefore, we propose to maintain the current work RVUs for
this procedure.
Code 43249 (Upper gastrointestinal endoscopy including esophagus,
stomach, and either the duodenum and/or jejunum as appropriate; with
balloon dilation of esophagus (less than 30mm diameter)):
The RUC recommended an increase from 2.9 to 3.35 work RVUs for this
code based on increased complexity of the condition of patients
undergoing this procedure. The current work increment for ``balloon
dilation of esophagus (less than 30 mm diameter)'' is 0.51 RVUs for
both the esophagus and upper gastrointestinal endoscopy families. Since
this is the same procedure in both families, it is unclear why the work
should be increased to 0.96 work RVUs for the upper gastrointestinal
family only. Accepting the RUC recommendation would create a clear
rank-order anomaly. Therefore, we are proposing to maintain the current
work RVUs for this code.
Code 43259 (Upper gastrointestinal endoscopy including esophagus,
stomach, and either the duodenum and/or jejunum as appropriate; with
endoscopic ultrasound examination):
The RUC recommended an increase in work RVUs from 4.59 to 8.59
based on the complexity of the equipment and the skill and judgement
required. The RUC also noted that the survey results supported this
procedure as more difficult than an endoscopic retrograde cholangio-
pancreatography (ERCP). The RUC then used the following building-block
methodology: (1) The RUC added 1.5 work RVUs, which was approximately
75 percent of the difference between the RUC recommendation from the
last 5-year review (6.11 work RVUs) and the work RVUs that we assigned
(4.0 work RVUs). (2) The RUC then added 2.2 work RVUs, which are the
work RVUs of code 93312. Not only do we disagree with the RUC
methodology for this recommendation, but we also note that the RUC has
used the current work RVUs for code 43259 to value not only other
gastrointestinal transendoscopic ultrasound procedures but also many
transendoscopic ultrasound guided biopsy codes. We would also note that
the RUC has recently re-evaluated code 43231, Esophagoscopy, rigid or
flexible; with endoscopic ultrasound examination, and will be sending a
new recommendation to us regarding the work valuation of this
procedure. Accepting the RUC recommendation for this code would be
inconsistent with the RUC's reevaluation of code 43231, would
invalidate the work valuation of many other gastrointestinal endoscopy
[[Page 31062]]
codes, and would create numerous rank-order anomalies. Therefore, we
propose to maintain this code at its current work RVUs.
Codes 43263 (Endoscopic retrograde cholangio-pancreatography
(ERCP); with pressure measurement of sphincter of Oddi (pancreatic duct
or common bile duct)), 43265 (ERCP; with endoscopic retrograde
destruction, lithotripsy of stone(s), any method), and 43269 (ERCP;
with endoscopic retrograde removal of foreign body and/or change of
tube or stent):
The RUC recommended an increase in work RVUs from 6.19 to 7.29 for
code 43263 based on the need to measure pressures in both the biliary
and pancreatic sphincters as well as the need for prolonged
postoperative monitoring. The RUC arrived at its recommendation by
adding 1.1 work RVUs (the value of code 99214) to the current work
RVUs. We disagree with valuing a post procedure observation period as
equal to an evaluation and management service. Furthermore, increasing
the value of this code while not adjusting the values of codes 43262,
43267, and 43268 creates clear rank-order anomalies.
The RUC recommended an increase in work RVUs from 8.9 to 10.02 for
code 43265 based on a rank-order anomaly with code 43264. The RUC
compared survey times to the Harvard study times for this code and used
a building-block method to arrive at its recommendation. We do not
fully understand the RUC methodology and disagree with the conclusion.
The Harvard study time data show less time for code 43265 than for code
43264, which would indicate that the current valuations of these codes
are correct. Moreover, increasing the value of 43265 while not
adjusting codes 43264, 43267, and 43268 would create clear rank-order
anomalies.
The RUC recommended an increase in work RVUs from 6.04 to 8.21 for
code 43269 based on a rank-order anomaly between this code and code
43268. The RUC used a building-block methodology adding 0.82 work RVUs
to the work RVUs of code 43268 (7.39) to arrive at its recommendation.
We disagree with the RUC methodology of using an evaluation and
management service to arrive at its recommendation since this is an
invasive procedure. Furthermore, we believe increasing the value of
this code creates a rank-order anomaly with codes 43271 and 43272.
Therefore, we are proposing maintaining the current work RVUs of all
three of these codes.
Codes 44388 (Colonoscopy through stoma; diagnostic with or without
collection of specimen(s) by brushing or washing (separate procedure)),
44389 (Colonoscopy through stoma; with biopsy, single or multiple),
44390 (Colonoscopy through stoma; with removal of foreign body), 44391
(Colonoscopy through stoma; with control of bleeding, any method) 44392
(Colonoscopy through stoma; with removal of tumor(s), polyp(s), or
other lesion(s) by hot biopsy forceps or bipolar cautery), and 44393
(Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or
other lesion(s) not amenable to removal by hot biopsy forceps, bipolar
cautery or snare technique).
These codes are in the same family of codes, and the RUC
recommended increases in work RVUs for all these codes based on a
misvaluation of the base code in this family of codes, code 44388. The
RUC valued it similarly to code 45378. We disagree. We think this
creates a clear rank-order anomaly between the value of this family and
the value of the colonoscopy family of codes beginning with code 45378.
Colonoscopy through a stoma is clearly less work than colonoscopy of
the complete colon and it has been valued as such since the inception
of the physician fee schedule. We question the accuracy of the surveyed
intraservice time for this service. Because of our nonacceptance of the
increase in work RVUs for the base code in this family, we must also
not accept the recommendations for all other increases in work RVUs for
other codes in this family. Moreover, the recommendations create
increments of work for ``biopsy, single or multiple,'' ``removal of
foreign body,'' ``control of bleeding, any method,'' ``removal of
tumors,'' and ``ablation of tumors,'' which are inconsistent with the
same increments for the colonoscopy family of codes beginning with code
45378. Accepting these RUC recommendations would create clear rank-
order anomalies that do not currently exist. Therefore, we are
proposing to maintain the current work RVUs for these procedures.
Code 45380 (Colonoscopy, flexible, proximal to splenic flexure;
with biopsy, single or multiple).
The RUC recommended an increase in work RVUs from 3.98 to 4.44 for
this code based on the increased number of biopsies generally taken
during this procedure and the increased difficulty in removing these
polyps. The current work increment for ``biopsy, single or multiple''
for gastrointestinal endoscopic procedures is 0.3 work RVUs. Accepting
the RUC recommendation would create a clear rank-order anomaly.
Moreover, we note that this code is also used for single biopsies that
would become significantly overvalued if we accepted the RUC
recommendation. Therefore, we are proposing to maintain the current
work RVUs for this code.
In summary, we believe the only way to accurately value
gastrointestinal endoscopy procedures is to evaluate the entire series
of codes, including all families of codes (esophagus, upper
gastrointestinal, ERCP, and colonoscopy etc.) at the same time. Only
then can appropriate incremental work RVUs be determined without
creating rank-order anomalies. We would also suggest that the RUC
consider reorganization of all these codes to facilitate more accurate
coding (for example, to determine whether every family of codes needs a
code for ``removal of foreign body'' or whether the base code be
revalued to include more procedures than it currently does).
We suggest that while the RUC is reevaluating these codes that it
delay making recommendations on any new codes for this series so that
conflicting recommendations are not made and the chance of creating
rank-order anomalies is minimized.
With respect to the RUC recommendation concerning reporting and
payment of conscious sedation codes 90141 and 90142, we will be
reviewing data concerning this issue. Any proposals we would have
concerning payment and reporting of conscious sedation codes would be
the subject of future rulemaking.
9. Pulmonary Medicine/Critical Care
Comment: Several specialty groups, including the societies for
pulmonary medicine and critical care, indicated that codes 36620 and
36489 were undervalued. Commenters indicated that the work RVUs for
code 36489 should be greater than the work RVUs for the reference
service code, 36010, because there is more work involved. Commenters
also stated that code 36620 is undervalued as compared to the reference
code 36140, because there are more variables affecting the work
involved with this procedure.
These specialty groups also requested that codes 99291 and 99292 be
evaluated because the groups claimed they were undervalued.
RUC Recommendation:
For code 36489, the RUC noted that there is additional work and
postoperative time involved in this procedure as compared to that of
the reference service code 36010, and recommended work RVUs of 2.50
which are higher than the reference service code 36010 (2.43), which
corrects the rank-order anomaly. With respect to 36620, the RUC
compared this
[[Page 31063]]
procedure to the reference service (code 36140) and agreed that this
service appeared to be undervalued. However, the RUC was concerned that
anesthesiologists who perform this procedure over 80 percent of the
time did not comment or participate in the survey conducted by the
specialty groups. The RUC concluded that code 36620 should be referred
to the CPT Editorial Panel to clarify the appropriate use of this code.
The RUC recommended maintaining the work RVUs for critical care
services (codes 99291 and 99292) due to the lack of compelling evidence
to recommend an increase in the work RVUs above the 2001 work RVUs of
4.00 and 2.00, respectively.
HCFA Proposal:
We have reviewed and propose to accept all of the RUC
recommendations for the pulmonary medicine and critical care codes.
10. Cardiology
Comment: The American College of Cardiology (ACC) recommended
review of three procedure codes under the 5-year refinement. They are
code 93350, which was not reviewed during the first 5-year review but
which the ACC believes is undervalued; and codes 33234 and 33235, which
ACC argues are undervalued because it does not believe the codes
reflect the level of difficulty associated with the procedures.
RUC Recommendation:
The RUC supported an increase in the work RVUs for code 93350 to
account for the increased work and more complex conditions of the
patient population as supported by survey information submitted. The
RUC recommendation was to increase the work RVUs to 1.48. For codes
33234 and 33235, they recommended that no change be made in the work
RVUs because both procedures had been recently reviewed by the RUC.
HCFA Proposal:
We have reviewed and propose to accept all of the RUC
recommendations for the cardiology codes.
11. Pediatrics
Comment: The American Academy of Pediatrics (AAP) submitted
approximately 40 codes involving several specialty areas and indicated
that they believed these services are undervalued, particularly when
they are provided to the pediatric population. A few of these codes
were also submitted by other specialty groups and are discussed under
those areas (codes 29450, 99291, and 99292). The AAP subsequently
indicated to the RUC that they were not interested in pursuing the
review of the work RVUs for the following codes for this 5-year review:
11100, 11730, 17000, 17003, 17004, 20600, 36600, 52300, 52327, and
52340.
RUC Recommendation:
For codes 36400 and 36405, the RUC agreed that an increase in the
work RVUs appeared to be warranted and recommended work RVUs of 0.38
and 0.32, respectively. However, for codes 94640, 99440, 99233, 99273,
and 99274, the RUC indicated that compelling evidence was not provided
to suggest a recommendation to increase the work RVUs and thus the
current RVUs should be maintained for these services.
The RUC recommended that the following codes be submitted to the
CPT Editorial panel for further consideration: 12001, 12002, 36406,
36520, 50200, 90935, 90937, 90945, 90947, 90989, 90993, 90997, 94664,
and 94665.
For codes 99295, 99296, 99297, 99298, and 99436, the RUC
recommended no change in the work RVUs for these services because these
services had recently been reviewed by the RUC.
HCFA Proposal:
We have reviewed and propose to accept all but two of the RUC
recommendations for the pediatric codes.
For code 36400 (Venipuncture, under age 3 years; femoral, jugular
or sagittal sinus), the RUC recommended an increase in work RVUs from
0.18 to 0.38. The RUC survey compared this code to code 36410 (Drawing
blood, child over 3 or adult, necessitating physician's skill (separate
procedure), for diagnostic or therapeutic purposes) (work RVUs of
0.18). The survey times indicated that the pre-, intra-, and
postservice times for code 36400 were less than the times for code
36410. The median work RVUs from the survey were 0.71, and the 25th
percentile work RVUs were 0.30. The specialty society recommended work
RVUs of 0.71, citing the change in population of patients requiring
this procedure (being younger and smaller). The RUC also compared code
36400 to code 99212 (Office/outpatient visit, established patient) with
work RVUs of 0.45 and believed the work RVUs of code 36400 were
comparable to the work RVUs of code 99212). The RUC then recommended
work RVUs between the 25th percentile of the survey and the work RVUs
of code 99212. We do not believe it is appropriate to compare the work
RVUs of a venipuncture to the work of an evaluation and management
service. Furthermore, we are concerned about the spread in the survey
work RVUs from 0.30 at the 25th percentile to 0.71 at the median. In
view of the survey times being less than the reference code (with work
RVUs of 0.18), the inconsistency of the survey times with the survey
RVUs, and the inappropriate comparison to an evaluation and management
service, we are proposing to continue the work RVUs of code 36400 as
0.18 work RVUs.
For code 36405 (Venipuncture, under age 3 years; scalp vein), the
RUC recommended an increase in work RVUs from 0.18 to 0.32. The survey
compared code 36405 to code 36410. The pre-, intra-, and postservice
times for code 36405 were less than the times for the reference code.
The survey RVUs were widely spread with the 25th percentile work RVUs
being 0.2 and the median work RVUs being 0.4. The RUC also compared
code 36405 to code 99212 (0.45) and recommended a value between the
survey 25th percentile work RVUs and the work RVUs for code 99212. Our
concerns about this recommendation are similar to the concerns about
the recommendation for code 36400. In view of the survey times, the
wide range of survey work RVUs, and the inappropriate comparison to an
evaluation and management service, we are proposing to continue the
work RVUs of code 36405 at 0.18.
12. Pediatric Surgery
Comment: The American Pediatric Surgical Association (APSA) stated
that the pediatric surgery procedure codes are misvalued and included
recommended work RVUs. While they suggested reductions in the work RVUs
of codes 46705 and 46715 to retain relativity in the family of
services, they believed that the majority of the codes they provide are
significantly undervalued. The association justifies the need to
increase the work RVUs for these services based on one or more of the
following rationales:
A change in practice and technology.
A change in the patient population for which the code is
most frequently applied.
An undervaluation of the postservice work in the global
period.
Rank-order anomalies.
Extended postoperative critical care. It is the provision
of very intensive, prolonged services with long episodes of critical
care and long hospital stays that account for the very high work RVUs
recommended for some procedures. APSA subsequently indicated that they
did not want to pursue review of two codes under the 5-year review:
43305 and 60280.
RUC Recommendation:
The RUC recommended that the suggested decreases in the work RVUs
[[Page 31064]]
for codes 46705 and 46715 be implemented. The recommended work RVUs are
6.90 for code 46705 and 7.20 for code 46715.
Based on the information provided by the specialty society, the RUC
recommended increasing work RVUs for the following codes to address the
undervalued physician work in the intra- and postservice periods, the
extended critical care services, and a change in patient population:
39503 (95.00); 44055 (22.00); 46716 (15.07); 46730 (26.75); 46735
(32.17); 46740 (30.00); 46742 (35.80); 46744 (52.63); 46746 (58.22);
46748 (64.21); 49215 (33.50); and 49605 (76.00).
The RUC did not receive compelling evidence to suggest that an
increase is needed in the work RVUs for these codes: 36822, 45120,
45121, 47701, and 49606.
The RUC recommended that the following codes be referred to the CPT
Editorial Panel for clarification and review: 21740, 43310, 43312,
49495, and 49496. In some instances, new codes may need to be created
to accurately value services performed on the pediatric and adult
population.
HCFA Proposal:
We propose to accept all but two of the RUC recommendations for the
pediatric surgery codes. The RUC recommended large increases in work
RVUs for codes 39503 (Repair, neonatal hernia, with or without chest
tube insertion and with or without creation of ventral hernia) and
49605 (Repair of large omphalocele or gastrochsis; with or without
prosthesis) for both of these procedures (an increase from 37.54 to
95.0 work RVUs for code 39503 and from 24.94 to 76.0 work RVUs for code
49605). These increases were based entirely on the increase of
postoperative work required for these procedures, resulting in an
increase of approximately 50 work units for each code. Both procedures
are performed on neonates who require prolonged stays in the intensive
care unit postoperatively. We understand that the postoperative care
may be performed by the surgeon, the intensivist, or both physicians.
In situations where the postoperative care is provided by both
physicians, we could make duplicate payments for postoperative care if
we continue to value these as 90-day global procedures. To permit the
physician who is performing the postoperative care to be appropriately
paid, but prevent duplicate payment for the same services, we are
considering a reduction in the global period (for example, making the
global period 10 or 0 days). If we shortened the global period for
these services, appropriate work RVUs consistent with this change would
need to be developed. If the surgeon provides postoperative care
outside of the 10-day global period (that is, 10 days after the date of
surgery)or outside of the 0-day global period (that is, the day after
surgery) he or she would bill separately for those services. Moreover,
if the intensivist provides the postoperative care, then the
intensivist would bill for the service, and there would be no duplicate
payment to the surgeon.
Based on the above discussion, we are proposing to maintain the
current RVUs for these two CPT codes (39503 and 49605) as an interim
for 2002 and would ask the RUC to submit work RVU recommendations for
these codes valued with reduced global periods (a 0-day or 10-day
period). We would consider the RUC recommendations and make a proposal
to initiate a change to the global period as well as associated RVUs in
next year's proposed rule. We invite comments on the issue of reducing
the global period for these services and welcome any alternative
suggestions that we could consider that address our concerns of
eliminating duplicate payment.
13. Radiology
Comment: The American College of Radiology (ACR) identified three
codes that they believe are undervalued. The code 76065, radiologic
examination of an infant, is most commonly performed in the situation
of alleged child abuse and requires a significant amount of physician
work. Additionally, radiologists indicated that the work RVUs for two
mammography procedure codes (codes 76090 and 76091) are not reflective
of the amount of physician work necessary to perform all the
requirements for the government regulated procedures and ACR standards.
The level of quality control and quality assurance requirements
instituted by the Food and Drug Administration (FDA) and Mammography
Quality Standards Act of 1992 (MQSA) have increased the level of
physician time outside of the direct patient care time. The current
work RVUs assigned to these codes are not adequate to perform this
procedure in accordance with Federal regulations or ACR standards. ACR
contended the combination of increased mental effort and judgement,
psychological stress, time, and intensity mandate that the work RVUs
for these codes should be increased.
RUC Recommendation:
The RUC noted that the intensity for code 76065 is higher than the
reference service code 76062 and that for intraservice work the
physician typically reviews more films. The RUC recommended work RVUs
of 0.70 for code 76065. For the mammography procedure codes, the RUC
was in agreement that as a result of the revisions of the MQSA
requirements, which require the physician to code radiologic results
using BIRADs terminology and require that separate reports be sent to
the patient and referring physician, the codes result in increased
physician time, mental effort, and judgement. In addition, code 76091
is a bilateral mammography requiring two studies to be performed. Based
on survey information, the RUC determined the 25th percentile of the
survey was the appropriate value and recommended work RVUs of 0.70 for
code 76090 and 0.87 for code 76091.
HCFA Proposal:
We have reviewed and propose to accept all of the RUC
recommendations for the radiology codes discussed above.
We would also note that section 104 of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act of 2000 (Public Law 106-
554) puts screening mammography under the physician fee schedule for
services furnished beginning January 1, 2002. We will include our
recommendation of the work RVUs for this service for CY 2002 as part of
the physician fee schedule proposed rule for CY 2002.
Because this will be a new code in the physician fee schedule, we
have asked the RUC to recommend work RVUs for screening mammography.
14. Plastic Surgery
Comment: The American Society of Plastic Surgery (ASPS) requested
that codes 42205 and 49905 be reviewed under the 5-year review. ASPS
indicated that there currently is a rank-order anomaly for code 42205
that was created when other codes in the family of codes were reviewed
and increased during the first 5-year review. They recommended an
increase to the work RVUs (9.59 to 12.0) for this code that would
reestablish rank-order in the cleft palate family of codes. With
respect to code 49905, ASPS stated that this code is currently
designated as an add-on code, which was not the intent of the specialty
group when they submitted the proposal to the AMA CPT Editorial Panel
in 1991 for creation of this code. They also disagree with our
assumption that pre- and postoperative work was included in the RUC-
recommended work RVUs that we reduced. ASPA recommended that code 49905
be changed from an add-on to a primary procedure code with a 90-day
global period and be assigned work RVUs
[[Page 31065]]
comparable to those of code 15374 (17.79).
RUC Recommendation:
The RUC reviewed code 42205 and recommended an increase in the work
RVUs (for work RVUs of 13.29), which will correct the existing rank-
order anomaly in this family of codes. The RUC recommended that code
49905 be referred to the CPT Editorial Panel for review.
HCFA Proposal:
We have reviewed and proposed to accept the RUC recommendations for
the plastic surgery codes.
C. Other Comments
1. Anesthesia Services
The American Society of Anesthesiologists (ASA) contended that the
work of anesthesia services is undervalued by almost 31 percent. (This
initial request was subsequently adjusted based on additional
discussions with the RUC.)
As required by law, we base Medicare payments for anesthesia
services on allowable base and time units. We have developed a uniform
relative value guide in which the base unit per anesthesia code is
largely based on the American Society of Anesthesiologists' 1988
relative value guide. Anesthesiologists report the actual anesthesia
time for each procedure on the claim, and the carrier converts the time
to time units. The carriers then multiply the sum of the base units and
time units by the anesthesia conversion factor.
We used the results of the original Harvard Study on work to
determine the adjustment to the anesthesia CF under the physician fee
schedule in 1992. (Anesthesia services do not have work RVUs.
Therefore, if work RVUs of other physician services are increased an
adjustment has to be made to the anesthesia CF so that the work of
anesthesia services remains on the same scale as other physician work.)
In the first 5-year review of work, we accepted the RUC's
recommendation that the work of anesthesia services was undervalued by
22.76 percent, which resulted in a 16 percent increase in the
anesthesia CF.
The approach to this 5-year review used by the ASA involves a
physician survey and a consensus panel review. The survey was sent to
262 members of the ASA in a geographically representative sample.
Eighty-five surveys were returned from respondents who were
geographically representative of the specialty as a whole. The findings
of the survey were presented to an expert consensus panel of 16
practicing anesthesiologists from the ASA's Relative Value System (RVS)
Committee. The work of the anesthesia service was uniformly divided
into five components. These components are--preoperative evaluation,
equipment and supply preparation, induction period, postinduction
anesthesia period, and postoperative care and visits. The survey median
times were assigned to each of the five components. The consensus panel
assigned the work RVUs of an evaluation and management code, usually
codes 99202 or 99201, to the preoperative evaluation. The consensus
panel developed a code-specific survey time estimate and intensity
value for equipment and supply preparation. For postoperative care and
visits, the consensus panel assigned work RVUs equivalent to those of
an evaluation and management code, usually code 99211 or 99231. The
survey median time for the postinduction anesthesia period was divided
in quintiles and each quintile was assigned intensity work RVUs ranging
from 0.026 to 0.085. The consensus panel identified the typical
anesthetic by procedure code and generally used the intensity of code
31500, Intubation, endotracheal, emergency procedure, a similar CPT
code, to value the work. This methodology was used for 19 high-volume
surgical codes requiring anesthesia and representing a reasonable
variety of surgical services.
The following illustrates this approach for anesthesia code 00404
and the underlying surgical code 19240 (Modified radical mastectomy):
------------------------------------------------------------------------
Work RVUs
------------------------------------------------------------------------
Preanesthesia Median Time.................... 15 min.
Preanesthesia reference code 99202.. 0.88
Equipment and Supply Preparation Median Time. 10 min. 0.14
Induction Period Procedure Time.............. 10 min. 0.93
Post Induction Anesthesia Period:
Level 1 Time............................. 87 min.
Level 2 Time............................. 10 min.
Level 3 Time............................. 10 min.
Level 4 Time............................. 0 min.
Level 5 Time............................. 0 min. 3.09
Postanesthesia Time.......................... 14 min.
Postanesthesia Reference Code 99231. 0.64
Total Work RVUs.......................... 5.68
------------------------------------------------------------------------
For each code, the total work RVUs were compared to a Medicare fee
schedule imputed work value. The Medicare imputed work value is
computed by multiplying the average allowed anesthesia charge per code
by the anesthesia work share and dividing by the national CF. The
average anesthesia allowed charge is determined by surgical code from
HCFA's 5 percent Beneficiary File.
Based on this analysis, the ASA requested a 24 percent increase in
anesthesia work.
RUC Recommendation:
The RUC furnished no recommendation on anesthesia services; instead
it assigned to a newly created workgroup the responsibility for
reviewing anesthesia services in the context of the physician fee
schedule. The ASA will be working with this workgroup on clinical
issues, such as induction and postinduction intensity RVUs.
HCFA Proposal:
We propose to make no changes to the anesthesia CF at this time to
reflect the 5-year review of physician work for anesthesia services.
However, we may make changes in response to recommendations the RUC may
provide.
2. Spine Injection Procedures
Comment: The American Society of Anesthesiologists submitted a
request for re-evaluation of seven spinal injection codes that they,
along with several other medical associations, had expressed concern
about when the codes were revalued for CY 2000. They continue to
believe the work RVUs
[[Page 31066]]
assigned by the RUC in 1999 and forwarded to HCFA were appropriate.
RUC recommendation:
In 1999, when the RUC forwarded revised work RVUs, we agreed with
the relativity of the four injection codes (62310, 62311, 62318, and
62319), but applied a budget-neutrality factor that the specialties
believe is inappropriate. In 1999, we also decreased the RUC-
recommended work RVUs for codes 72275, 62263, and 76005 based on our
belief that the values were too high. The RUC has now reviewed the
original surveys and subsequent recommendations and continues to
believe that its 1999 recommendations for work RVUs for these codes are
appropriate. They recommended the following work RVUs for these
services: 62310 (2.20); 62311 (1.78); 62318 (2.35); 62319 (2.15); 62263
(7.20); 72275 (0.83) and 76005 (0.60). (Note: for code 76005, the work
RVUs were 0.60 for this service on the CY 2000 fee schedule)
HCFA Proposal:
We propose to reject the RUC recommendations for these codes for
the following reasons:
Codes 62310 (Single injection (not via indwelling catheter), not
including neurolytic substances, with or without contrast (for either
localization or epidurography), of diagnostic or therapeutic
substance(s) (including anesthetic, antispasmodic, opioid, steroid,
other solution), epidural or subarachnoid; cervical or thoracic)),
62311 (Single injection (not via indwelling catheter), not including
neurolytic substances, with or without contrast (for either
localization or epidurography), of diagnostic or therapeutic
substance(s) (including anesthetic, antispasmodoic, opioid, steroid,
other solution), epidural or subarachnoid, lumbar, sacral(caudal)),
62318 (Injection, including catheter placement, continuous infusion or
intermittent bolus, not including neurolytic substances, with or
without contrast(for either localization or epidurography), of
diagnostic or therapeutic substance(s) (including anesthetic,
antispasmodic, opioid, steroid, other solution), epidural or
subarachnoid; cervical or thoracic), and 62319 (Injection, including
catheter placement, continuous infusion or intermittent bolus, not
including neurolytic substances, with or without contrast (for either
localization or epidurography), of diagnostic or therapeutic
substance(s) (including anesthetic, antispasmodoic, opioid, steroid,
other solution), epidural or subarachnoid; lumbar, sacral (caudal)).
These were new codes for CY 2000. The RUC submitted recommendations
for these codes in CY 1999. We accepted the RUC recommendations and
made a work-neutrality adjustment because these new codes replaced
codes under which these services were billed before 2000. The RUC and
several specialty societies disagreed with the data we used in making
our work-neutrality adjustment. (Work-neutrality adjustments ensure
that the recommendations for work RVUs for new and revised services are
adjusted so that the sum of the new or revised work RVUs (weighted by
projected frequency of use).) for a family of codes will be the same as
the sum of the current work RVUs (weighted by frequency of use). We
have reviewed the data used to make our work-neutrality adjustment and
have determined that the adjustment made was accurate. The RUC work
recommendations for the 5-year review are identical to the
recommendations we received and evaluated in CY 1999. In view of this,
we are proposing to maintain the current work RVUs for these services.
Code 62263 (Percutaneous lysis of epidural adhesions using solution
injection (eg, hypertonic saline, enzyme) or mechanical means (eg,
spring-wound catheter) including radiologic localization (includes
contrast when administered).
This was a new code for CY 2000. We received RUC recommendations in
CY 1999 for this code and disagreed with them. The RUC recommendation
was 7.20 work RVUs, and we made the interim work RVUs 6.02 for CY 2000.
In the summer of 2000, we convened a multispecialty review panel that
reviewed this code in detail and recommended work RVUs of 6.14. We
finalized the multispecialty review panel recommendation of 6.14 work
RVUs for CY 2001. The current RUC recommendation is identical to the
RUC recommendation from CY 1999. We find no compelling reason to change
the RVUs for this procedure, especially since this procedure was
reviewed by a multispecialty panel less than 1 year ago. We propose to
continue the current work RVUs for this procedure.
Code 72275 (Epidurography, radiological supervision and
interpretation).
This code was new for CY 2000. The RUC submitted a recommendation
for 0.83 RVUs. We disagreed with this recommendation and made the
interim work RVUs 0.54 for CY 2000. We submitted this code to a
multispecialty review panel that recommended an increase to 0.76 work
RVUs that we implemented for CY 2001. The RUC now submits a
recommendation of 0.83 work RVUs for this procedure, identical to its
prior recommendation. In the absence of compelling reasons to change
the current work RVUs, and because this code was reviewed by an
objective multispecialty panel less than 1 year ago, we are proposing
to continue the current work RVUs.
Additionally, codes 62310, 62311, 62318, 62319, 62263, and 72275
were reviewed and finalized in the July 2000 Multispecialty Refinement
Panels for new and/or revised services. Since the RUC recommendations
have offered no evidence in addition to that which was presented at the
July 2000 Multispecialty Refinement Panel Meeting, we propose to retain
the existing work RVUs.
3. Biofeedback
Comment: One organization, Medcare, requested review of the work
and practice expense RVUs for biofeedback codes 90911 and 90901, as it
believes that these codes currently are undervalued.
RUC Recommendation:
The RUC reviewed the original survey data for code 90911 and noted
that while we had decreased the original RUC-recommended work RVUs, we
received no further information to indicate that our rationale for
reducing the work RVUs was inappropriate, and the specialty societies
that perform the service did not present new information in response to
the decrease. The RUC recommended that the current RVUs be maintained
since it received no compelling evidence to recommend an increase in
work RVUs.
HCPAC Recommendation:
The HCPAC recommended that the current work RVUs be maintained for
code 90901 because we received no additional information from the
specialists who perform this service to warrant an increase in work
RVUs.
HCFA Proposal:
We reviewed and propose to accept the RUC and HCPAC recommendations
for biofeedback services.
4. Surgical Management of Burn Wounds
Comment: The American Burn Association (ABA) submitted codes
commonly used for the surgical management of burn wounds (codes 15000
through 15641). The ABA requested assignment of RVUs for these codes
that more appropriately reflect the work involved. ABA also requested
the creation of more specific codes that would obviate the need for
``G'' codes. The ABA indicated that these codes should be exempt from
CPT payment policies with respect to the 90-day global period, multiple
procedures and
[[Page 31067]]
staged procedures due to the unique clinical case management of burns.
RUC Recommendation:
The RUC recommended that the following codes be reviewed by the CPT
Editorial Panel: 15000, 15001, 15100, 15101, 15120, 15121, 15350,
15351, 15400, and 15401.
HCFA Proposal:
We have reviewed and proposed to accept the RUC recommendation for
these codes.
5. Transplantation
Comment: The American Society for Transplant Surgeons requested
reassessment of the work RVUs for code 47134 because the current work
RVUs do not accurately reflect the work involved (it contended that
over 50 percent of these procedures involve right lobectomies that are
more labor intensive than left lobectomies, on which the current work
RVUs are based). As an alternative, the American Society for Transplant
Surgeons also suggested referral to the CPT Editorial Panel for
consideration of creation of an additional code.
RUC Recommendation:
The RUC recommended that code 47134 be forwarded to the CPT
Editorial Panel for further consideration.
HCFA Proposal:
We have reviewed and propose to accept the RUC recommendation for
this code.
6. Arthroscopy Services
Comment: The Arthroscopy Association of North America (AANA)
requested that work for other arthroscopy services be reconsidered in
light of the increase in work RVUs for code 29848 in the last 5-year
review. The AANA also requested a specific increase in the work RVUs
for code 29889. Subsequently, the specialty society chose not to pursue
its request for consideration for code 29881.
RUC Recommendations:
For code 29883, the RUC noted that this service consisted of two
procedures, medial and lateral meniscus repair. Because this service
encompassed the work involved in code 29882 plus additional work for
the lateral meniscus repair, and using the building-block approach, the
RUC recommended work RVUs of 11.05 for this service. For code 29889,
the RUC indicated that, due to the increase in post-and intraservice
time, the work RVUs should be increased to 16.00.
HCFA Proposal:
We have reviewed and propose to accept the RUC recommendation for
this code.
7. Wheelchair Management
Comment: The American Physical Therapy Association requested review
of code 97542.
HCPAC Proposal: We had revised the recommended work RVUs for this
code when it was previously reviewed by the HCPAC in 1995, based on a
comparison of code 97542 to code 97032 rather than to code 97110. The
HCPAC concluded that our comparison was incorrect because code 97032 is
the application of a modality, while code 97542 requires additional
skills because the patients requiring this service have cognitive,
sensory, and physical disabilities. In addition, HCPAC indicated that
we may not have understood that this procedure is reported very
infrequently. The HCPAC supports its original recommendation of 0.45
work RVUs for this service.
HCFA Proposal:
We have reviewed and propose to accept the HCPAC recommendation for
this code.
8. Psychological Testing
Comment: The American Psychological Association recommended that we
review five psychological testing codes (96100, 96105, 96110, 96115,
and 96117).
HCPAC Recommendation:
The HCPAC did not have any recommendations for these codes at this
time. However, it indicated that the American Psychological Association
may request HCPAC to review these services at a future date once
additional information is collected.
HCFA Proposal:
We propose to make no changes at this time. We believe more precise
definitions of these services may be necessary to value them properly
and to ensure proper coding and billing of these services.
9. Podiatric Services
Comment: The American Podiatric Medical Association submitted five
codes (trim skin lesions/trim nails) for review (11719, 11055, 11056,
11057, and G0127) indicating that they are undervalued and do not
accurately reflect the level of physician work involved.
HCPAC Recommendation:
The HCPAC reviewed these codes and had no information to support an
increase in work RVUs. However, the HCPAC requested that we review our
current utilization data to ensure that the original utilization
assumptions were correct. The HCPAC recommended that the current review
of data should be based on actual 1999 utilization data since these
codes were not fully implemented until April 1, 1998.
HCFA Proposal:
Taking into account the recommendation of the HCPAC, we propose to
review utilization data associated with the aforementioned codes to
ensure the original assumptions are still correct. We will publish our
final decision in the November 2001 final rule.
D. Other Issues
1. Critical Care Services in a Global Period
Validation of RUC recommendations for the work of many surgical
procedures included the use of a ``building-block'' methodology as
previously described. Before this 5-year review, the RUC compared the
work of a postoperative intensive care unit visit by the surgeon to a
level three subsequent hospital visit (code 99233) which is valued at
1.51 work RVUs. Now, for the first time since the inception of the
physician fee schedule, one of the ``building blocks'' the RUC used to
validate postoperative work by the surgeon in the intensive care unit
is code 99291 (Critical care, evaluation and management of the
critically ill or critically injured patient, first 30-74 minutes),
which is valued at 4.00 work RVUs. Specifically, the RUC validated the
postoperative work of several thoracic, vascular, and general surgical
procedures by comparing the surgeon's intensive care unit visits to
code 99291.
Current Medicare policy allows separate payment to the surgeon for
postoperative critical care services during the surgical global period
only when the patient has suffered trauma or burns. If the surgeon
provides critical care services during the global period, for reasons
unrelated to the surgery, that is separately payable as well.
The RUC recommendations have raised several issues for which we are
considering future action. In view of our desire to ensure that
Medicare beneficiaries have appropriate access to critical care
services, and to ensure that we make appropriate payments to physicians
furnishing postoperative critical care services to Medicare
beneficiaries, we are soliciting information and comments on the
following questions and issues:
1. If critical care (as described in CPT 2001) is provided
postoperative, who typically provides this care? The surgeon, an
intensivist, other physicians?
2. Do surgeons typically meet the CPT requirements for billing
critical care services (as described in CPT 2001)
[[Page 31068]]
when making intensive care unit visits on their postoperative patients?
3. Are surgeons currently performing more, or less, critical care
on their postoperative patients than they were at the time of the last
5-year review?
4. What is, or will be, the effect of ``closed'' intensive care
units (a unit staffed by dedicated intensivists who manage the care for
all patients in the intensive care unit) on who performs postoperative
critical care services?
5. What is the likelihood of making duplicate payment for critical
care services if the surgical global period is valued with the
inclusion of critical care in the postoperative work (for example, if
we also pay an intensivist for postoperative critical care services)?
6. If valuation of the surgical global period includes
postoperative critical care, are there concerns about additional
carrier scrutiny being applied to claims from intensivists for
postoperative critical care services?
7. Does valuation of the surgical global period with the inclusion
of postoperative critical care create an incentive for the surgeon to
either (a) not perform postoperative critical care services if there is
an intensivist available or (b) to not consult an intensivist if one is
available?
Below are some of the options we are considering:
Removing work RVUs for critical care services from the
surgical global period, valuing these services as subsequent hospital
visits and allowing surgeons to bill separately for critical care (for
an identified subset of surgical procedures where there is a high
likelihood that the surgeon is typically providing critical care
services).
Removing the work RVUs for critical care services from the
surgical global period, valuing these services as subsequent hospital
visits and not allowing surgeons to bill separately for critical care
services.
Leaving the work RVUs for critical care services in the
surgical global period, not allowing surgeons to bill separately for
critical care services, requiring surgeons to follow documentation
rules for critical care services and instructing carriers to make
payment for medically necessary critical care services furnished by
other physicians. (This option would facilitate tracking of critical
care services, permit appropriate medical record review, and provide a
basis to re-evaluate the work of the procedure.)
Valuing the surgeon's postoperative intensive care unit visits as
critical care services has raised a number of issues. We believe these
issues will require a change in payment policy to ensure that
postoperative critical care is appropriately paid. Therefore, we are
proposing to make the work RVUs for those surgical codes where any
postoperative intensive care unit visits were valued as critical care,
interim, until we address the issues discussed above.
2. Codes Referred to CPT
As discussed in sections B and C above, there were some codes that
commenters had submitted for review that the RUC recommended be
referred to the CPT Editorial Panel for clarification or consideration
of definitional changes. These codes are listed in Table 2, which
follows.
Table 2.--Codes Referred to CPT Editorial Panel From Five-Year Review of
Work Relative Value Units
------------------------------------------------------------------------
CPT/HCPCS code \1\ Mod Descriptor
------------------------------------------------------------------------
12001.................... ................. Repair superficial
wound(s)
12002.................... ................. Repair superficial
wound(s)
15000.................... ................. Skin graft
15001.................... ................. Skin graft add-on
15100.................... ................. Skin split graft
15101.................... ................. Skin split graft add-on
15120.................... ................. Skin split graft
15121.................... ................. Skin split graft add-on
15350.................... ................. Skin homograft
15351.................... ................. Skin homograft add-on
15400.................... ................. Skin heterograft
15401.................... ................. Skin heterograft add-on
20205.................... ................. Deep muscle biopsy
21740.................... ................. Reconstruction of sternum
23076.................... ................. Removal of shoulder lesion
24076.................... ................. Remove arm/elbow lesion
25076.................... ................. Removal of forearm lesion
27048.................... ................. Remove hip/pelvis lesion
27328.................... ................. Removal of thigh lesion
27619.................... ................. Remove lower leg lesion
33875.................... ................. Thoracic aortic graft
33877.................... ................. Thoracoabdominal graft
35381.................... ................. Rechanneling of artery
35541.................... ................. Artery bypass graft
35546.................... ................. Artery bypass graft
35551.................... ................. Artery bypass graft
35582.................... ................. Vein bypass graft
35641.................... ................. Artery bypass graft
35646.................... ................. Artery bypass graft
35840.................... ................. Explore abdominal vessels
35860.................... ................. Explore limb vessels
36406.................... ................. Drawing blood
36520.................... ................. Plasma and/or cell
exchange
36533.................... ................. Insertion of access device
36534.................... ................. Revision of access device
36535.................... ................. Removal of access device
36620.................... ................. Insertion catheter, artery
37615.................... ................. Ligation of neck artery
37618.................... ................. Ligation of extremity
artery
37700.................... ................. Revise leg vein
37720.................... ................. Removal of leg vein
37730.................... ................. Removal of leg veins
37735.................... ................. Removal of leg veins/
lesion
37760.................... ................. Revision of leg veins
37785.................... ................. Revision secondary
varicosity
43215.................... ................. Esophagus endoscopy
43310.................... ................. Repair of esophagus
43312.................... ................. Repair esophagus and
fistula
47134.................... ................. Partial removal, donor
liver
49495.................... ................. Repair inguinal hernia,
init
49496.................... ................. Repair inguinal hernia,
init
49905.................... ................. Omental flap
50200.................... ................. Biopsy of kidney
50230.................... ................. Removal of kidney
90935.................... ................. Hemodialysis, one
evaluation
90937.................... ................. Hemodialysis, repeated
eval
90945.................... ................. Dialysis, one evaluation
90947.................... ................. Dialysis, repeated eval
90989.................... ................. Dialysis training,
complete
90993.................... ................. Dialysis training, incompl
90997.................... ................. Hemoperfusion
94664.................... ................. Aerosol or vapor
inhalations
94665.................... ................. Aerosol or vapor
inhalations
------------------------------------------------------------------------
3. Budget Neutrality
Section 1848(c)(2)(B) of the Act requires that increases or
decreases in relative value units may not cause the amount of
expenditures for the year to differ by more than $20 million from what
expenditures would have been in the absence of these changes. If this
threshold is exceeded, we make adjustments to preserve budget
neutrality. This year, budget-neutrality adjustments will be required
for changes in work relative value units resulting from the 5-year
refinement. Revisions in payment policies, including the establishment
of interim and final relative value units for coding changes that will
be announced later this year, may result in additional budget-
neutrality adjustments.
We considered making the statutorily required budget-neutrality
adjustments
[[Page 31069]]
to account for the 5-year review of physician work by reducing all work
RVUs. We estimate that all work RVUs would have to be reduced by 0.7
percent under this option. Alternatively, we considered making an
adjustment to the physician fee schedule CF to meet the provisions of
section 1848(c)(2)(B). This option would require an estimated 0.3
percent reduction in the conversion factor. For the 5-year review, we
are proposing to reduce the conversion factor by 0.3 percent to meet
the provisions of section 1848(c)(2)(B).
HCFA Proposal:
We propose to make the budget-neutrality adjustment by reducing the
CF.
4. Calculation of Practice Expense and Malpractice Expense RVUs
As we noted in the November 2, 1999 final rule (64 FR 59427),
practice expense and malpractice expense RVUs were not subject to
comment and will not be recalculated (other than the change to practice
expense RVUs that result from changes in work) as part of the 5-year
review of work RVUs. Section 4505 of the BBA also provides for the
gradual 4-year transition for resource-based practice expenses, with
resource-based practice expenses becoming fully effective in CY 2002.
We are currently in the process of developing our annual physician fee
schedule proposed rule that will continue the 4-year refinement process
for resource-based practice expense RVUs.
Section 4505(f) of the Balanced Budget Act of 1997 (BBA) amended
section 1848(c)(2)(C) of the Act and requires us to implement resource-
based malpractice RVUs for services furnished beginning in CY 2000. A
methodology for establishing resource-based malpractice RVUs was
included in the November 1999 final rule and implemented January 1,
2000. In addition, based on concerns expressed by commenters, updated
premium data used under this methodology were obtained and used to
calculate malpractice RVUs for CY 2001.
Since resource-based malpractice RVUs were recently implemented,
and resource-based practice expenses are in the final phase of
transition to a fully resource-based system, these components are not
being included in this 5-year review. However, as stated above we
expect to publish our annual physician fee schedule proposed rule that
will propose continuing refinements to resource-based practice expense
RVUs.
5. Nature and Format of Comments on Work RVUs
We will accept comments on the proposed work RVUs for the codes
identified in the Addendum of this notice. We will also accept comments
on the anesthesia codes. Comments should discuss how the work
associated with a given CPT or HCPCS code is analogous to the work in
other services or discuss the rationale for disagreeing with the
proposed work RVU. We are especially interested in information or
arguments that were not presented in earlier comments.
III. Collection of Information Requirements
This document does not impose information collection and
recordkeeping requirements. Consequently it need not be reviewed by the
Office of Management and Budget under the authority of the Paperwork
Reduction Act of 1995 (44 U.S.C. 3501 et seq.)
IV. Response to Comments
Because of the large number of items of correspondence we normally
receive on Federal Register documents published for comment, we are not
able to acknowledge or respond to them individually. We will consider
all comment received by the date and time specified in the DATES
section of this preamble, and we will respond to the comments in the
physician fee schedule final rule.
V. Regulatory Impact Analysis
A. Overall Impact
We have examined the impacts of this proposed notice as required by
Executive Order 12866 (September 1993, Regulatory Planning and Review)
and the Regulatory Flexibility Act (RFA) (September 9, 1980 Public Law
96-354). Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, if regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety
effects, distributive impacts, and equity).
A regulatory impact analysis must be prepared for major rules with
economically significant effects ($100 million or more annually). While
the changes in the Medicare physician fee schedule due to the 5-year
review are budget neutral, they do involve a redistribution of Medicare
spending among procedures that will exceed $100 million. For this
reason, we are considering this to be a major rule. We estimate that
the aggregate amount of payments being redistributed among specialties
as a result of the 5-year review will be over $200 million.
The RFA requires agencies to analyze options for regulatory relief
of small businesses. For purposes of the RFA, small entities include
small businesses, nonprofit organizations and government agencies. Most
hospitals and most other providers and suppliers are small entities,
either by nonprofit status or by having revenues of $7.5 million or
less annually for physicians and $5 million or less for other
practitioners. For purposes of the RFA and based on small business
administration data for 1997 we estimate that there are 162,000
physician organizations that meet the definition of a small entity.
There are about 700,000 physicians and other practitioners who receive
Medicare payment under the physician fee schedule. Individuals and
States are not included in the definition of a small entity.
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis if a rule may have a significant impact on
the operations of a substantial number of small rural hospitals. This
analysis must conform to the provisions of section 603 of the RFA. For
purposes of section 1102(b) of the Act, we define a small rural
hospital as a hospital that is located outside of a Metropolitan
Statistical Area and has fewer than 100 beds.
Section 202 of the Unfunded Mandates Reform Act of 1995 also
requires that agencies assess anticipated costs and benefits before
issuing any rule that may result in expenditure in any one year by
State, local, or tribal governments, in the aggregate, or by the
private sector, of $110 million. We have determined that this rule has
no consequential effect on State, local or tribal governments. We
believe the private sector costs of this rule will fall below this
threshold as well.
For purposes of Executive Order 12866 and the RFA, we have prepared
the following analysis, which, together with the rest of this preamble,
meets all four assessment requirements. It explains the rationale for
and purpose of the proposed notice, details the costs and benefits of
the proposed notice, analyzes alternatives, and presents the measures
we considered to minimize burden on small entities. Section
1848(c)(2)(B) of the Act requires that increases or decreases in RVUs
may not cause the amount of expenditures for the year to differ by more
than $20 million from what expenditures would have been in the absence
of these changes. If this threshold is exceeded,
[[Page 31070]]
we make adjustments to preserve budget neutrality. This year, budget-
neutrality adjustments will be required for changes in work relative
value units resulting from the 5-year refinement. Revisions in payment
policies, including the establishment of interim and final relative
value units for coding changes that will be announced later this year,
may result in additional budget-neutrality adjustments.
We considered making the statutorily required budget-neutrality
adjustments to account for the 5-year review of physician work by
reducing all work RVUs. We estimate that all work RVUs would have to be
reduced by 0.7 percent under this option. Alternatively, we considered
making an adjustment to the physician fee schedule CF to meet the
provisions of section 1848(c)(2)(B) of the Act. This option would
require an estimated 0.3 percent reduction in the CF. For the 5-year
review, we are proposing to reduce the CF by 0.3 percent to meet the
provisions of section 1848(c)(2)(B) of the Act.
Table 3.--Percent Change in Total Payments by Specialty Resulting From the 5 Year Review of Work
----------------------------------------------------------------------------------------------------------------
Percent
change in Percent Total
Allowed total change in percent
Specialty charges payments total change in
(billions) from payments payments
increase in from change from 5 year
work in PE review
----------------------------------------------------------------------------------------------------------------
Anesthesiology.............................................. 1.5 1 0 1
Cardiac Surgery............................................. 0.3 5 1 6
Cardiology.................................................. 4.2 0 -1 -1
Chiropractor................................................ 0.4 0 0 0
Clinics..................................................... 1.6 0 0 0
Dermatology................................................. 1.4 0 0 0
Emergency Medicine.......................................... 1.0 0 0 0
Family Practice............................................. 3.3 0 0 0
Gastroenterology............................................ 1.2 0 0 0
General Practice............................................ 1.0 0 0 0
General Surgery............................................. 2.0 3 1 4
Hematology Oncology......................................... 0.6 0 -1 -1
Internal Medicine........................................... 7.1 0 0 0
Nephrology.................................................. 1.0 0 0 0
Neurology................................................... 0.9 0 0 0
Neurosurgery................................................ 0.4 0 0 0
Nonphysician Practitioner................................... 1.2 0 0 0
Obstetrics/Gynecology....................................... 0.4 0 0 0
Ophthalmology............................................... 3.9 0 0 0
Optometrist................................................. 0.5 0 0 0
Orthopedic Surgery.......................................... 2.3 0 0 0
Other Physician............................................. 1.6 0 0 0
Otolaryngology.............................................. 0.6 0 0 0
Pathology................................................... 0.6 0 0 0
Plastic Surgery............................................. 0.2 0 0 0
Podiatry.................................................... 1.1 0 0 0
Psychiatry.................................................. 1.1 0 0 0
Pulmonary................................................... 1.1 0 0 0
Radiation Oncology.......................................... 0.7 0 -1 -1
Radiology................................................... 3.3 0 -1 -1
Rheumatology................................................ 0.3 0 0 0
Suppliers................................................... 0.5 0 0 -1
Thoracic Surgery............................................ 0.5 4 1 5
Urology..................................................... 1.3 0 0 0
Vascular Surgery............................................ 0.3 2 0 2
----------------------------------------------------------------------------------------------------------------
Note: This table incorporates two separate budget neutrality adjustments. The increase in practice expense
relative value units is incorporated through a rescaling of all practice expense RVUs. In addition, all
physician fee schedule payments (not the work RVUs) are reduced to make the increase in physician work RVUs
budget neutral.
The table above shows the specialty level payment impact of changes
in work and practice expense relative values resulting from the 5-year
review. The table includes the effect of budget-neutrality adjustments
applied to the physician fee schedule CF. Since the practice expense
RVUs are based, in part, on physician work, the table also reflects
changes in practice expense RVUs that will result from the 5-year
review of physician work. The changes in practice expense RVUs
resulting from the changes in physician work RVUs were made budget
neutral by rescaling all practice expense RVUs. This table shows the
impact on payments per service at the specialty level that would result
only from the 5-year review of physician work RVUs.
We are in the process of developing our annual physician fee
schedule proposed rule that will make refinements in practice expense
RVUs and other policies that will affect payment for physician fee
schedule services in CY 2002. As part of the physician fee schedule
proposed rule, we expect to use revised physician times submitted to us
by the RUC in the methodology for determining practice expense RVUs.
The RUC is recommending that we use new time data for codes in which
they recommended a change in work RVUs. In addition, the RUC is
recommending a revision of the time data for many other codes. For some
specialties, we expect that use of the revised times will change the
impacts shown here.
In particular, it appears that the revised times submitted to us by
the
[[Page 31071]]
RUC are less than the times included in our database for many heart and
chest procedures. Our expectation is that use of the RUC recommended
times will result in a reduction in the practice expense RVUs for these
services that are predominantly performed by cardiac and thoracic
surgeons. This means that our expectation is that the total payment
increase shown here for these specialties will be less when the revised
times are used to determine the practice expense RVUs. In addition,
there may be other refinements to the practice expense RVUs or other
changes in policies that may result in a specialty level payment impact
for 2002 that we will announce in our proposed rule. We will show the
combined payment impact by specialty, as a result of the revised times
and other proposed policy changes, in our notice of proposed rulemaking
that we expect to be published shortly.
We will show the combined impact of all policy changes affecting
physician fee schedule payments in 2002 in one final rule that we
expect to be published no later than November 1, 2001.
Federalism: Executive Order 13132 establishes certain requirements
that an agency must meet when it promulgates a proposed rule (and
subsequent final rule) that imposes substantial direct requirement
costs on State and local governments, preempts State law, or otherwise
has Federalism implications. We have determined that this rule will not
impose substantial direct requirement costs on State and local
governments, preempt State law, or otherwise have Federalism
implications.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
(42 U.S.C. 1395k(a)(2)(F) and 1395l(i)(1) and (2)); 42 CFR 416.120,
416.125, and 416.130)
(Catalog of Federal Domestic Assistance Programs No. 93.774,
Medicare--Supplementary Medical Insurance Program)
Dated: April 17, 2001.
Michael McMullan,
Acting Deputy Administrator, Health Care Financing Administration.
Dated: April 23, 2001.
Tommy G. Thompson,
Secretary.
--------------------
\1\ All CPT codes and descriptors copyright 2000 American Medical
Association
[[Page 31071]]
Addendum--Codes Subject to Comment
------------------------------------------------------------------------
Proposed
CPT/HCPCS code \1\ Mod Descriptor work RVU
------------------------------------------------------------------------
G0127.............. ............ Trim nail(s)............. 0.11
11055.............. ............ Trim skin lesion......... 0.27
11056.............. ............ Trim skin lesion, 2 to 4. 0.39
11057.............. ............ Trim skin lesions, over 4 0.50
11402.............. ............ Removal of skin lesion... 1.61
11642.............. ............ Removal of skin lesion... 2.93
11642.............. ............ Removal of skin lesion... 2.93
11719.............. ............ Trim nail(s)............. 0.11
12001.............. ............ Repair superficial 1.70
wound(s).
12002.............. ............ Repair superficial 1.86
wound(s).
12011.............. ............ Repair superficial 1.76
wound(s).
13101.............. ............ Repair of wound or lesion 3.92
13131.............. ............ Repair of wound or lesion 3.79
13132.............. ............ Repair of wound or lesion 5.95
15000.............. ............ Skin graft............... 4.00
15001.............. ............ Skin graft add-on........ 1.00
15100.............. ............ Skin split graft......... 9.05
15101.............. ............ Skin split graft add-on.. 1.72
15120.............. ............ Skin split graft......... 9.83
15121.............. ............ Skin split graft add-on.. 2.67
15350.............. ............ Skin homograft........... 4.00
15351.............. ............ Skin homograft add-on.... 1.00
15400.............. ............ Skin heterograft......... 4.00
15401.............. ............ Skin heterograft add-on.. 1.00
19000.............. ............ Drainage of breast lesion 0.84
19100.............. ............ Biopsy of breast......... 1.27
19125.............. ............ Excision, breast lesion.. 6.06
19160.............. ............ Removal of breast tissue. 5.99
19162.............. ............ Remove breast tissue, 13.53
nodes.
19240.............. ............ Removal of breast........ 16.00
20205.............. ............ Deep muscle biopsy....... 2.35
20245.............. ............ Bone biopsy, excisional.. 7.78
21740.............. ............ Reconstruction of sternum 16.50
21800.............. ............ Treatment of rib fracture 0.96
23076.............. ............ Removal of shoulder 7.63
lesion.
23472.............. ............ Reconstruct shoulder 21.10
joint.
23485.............. ............ Revision of collar bone.. 13.43
23585.............. ............ Treat scapula fracture... 8.96
23615.............. ............ Treat humerus fracture... 9.35
23630.............. ............ Treat humerus fracture... 7.35
23680.............. ............ Treat dislocation/ 10.06
fracture.
24076.............. ............ Remove arm/elbow lesion.. 6.30
24435.............. ............ Repair humerus with graft 13.17
[[Page 31072]]
24545.............. ............ Treat humerus fracture... 10.46
25076.............. ............ Removal of forearm lesion 4.92
26562.............. ............ Repair of web finger..... 15.00
27048.............. ............ Remove hip/pelvis lesion. 6.25
27075.............. ............ Extensive hip surgery.... 35.00
27077.............. ............ Extensive hip surgery.... 40.00
27216.............. ............ Treat pelvic ring 15.19
fracture.
27217.............. ............ Treat pelvic ring 14.11
fracture.
27218.............. ............ Treat pelvic ring 20.15
fracture.
27226.............. ............ Treat hip wall fracture.. 14.91
27236.............. ............ Treat thigh fracture..... 15.60
27280.............. ............ Fusion of sacroiliac 13.39
joint.
27282.............. ............ Fusion of pubic bones.... 11.34
27284.............. ............ Fusion of hip joint...... 23.45
27328.............. ............ Removal of thigh lesion.. 5.57
27472.............. ............ Repair/graft of thigh.... 17.72
27513.............. ............ Treatment of thigh 17.92
fracture.
27536.............. ............ Treat knee fracture...... 15.65
27590.............. ............ Amputate leg at thigh.... 12.03
27619.............. ............ Remove lower leg lesion.. 8.40
27724.............. ............ Repair/graft of tibia.... 18.20
27822.............. ............ Treatment of ankle 11.00
fracture.
27823.............. ............ Treatment of ankle 13.00
fracture.
27828.............. ............ Treat lower leg fracture. 16.23
28299.............. ............ Correction of bunion..... 9.18
28322.............. ............ Repair of metatarsals.... 8.34
28420.............. ............ Treat/graft heel fracture 16.64
28445.............. ............ Treat ankle fracture..... 15.62
28705.............. ............ Fusion of foot bones..... 18.80
29450.............. ............ Application of leg cast.. 2.08
29450.............. ............ Application of leg cast.. 2.08
29883.............. ............ Knee arthroscopy/surgery. 11.05
29889.............. ............ Knee arthroscopy/surgery. 16.00
29889.............. ............ Knee arthroscopy/surgery. 16.00
31600.............. ............ Incision of windpipe..... 7.18
31622.............. ............ Dx bronchoscope/wash..... 2.78
31622.............. ............ Dx bronchoscope/wash..... 2.78
31625.............. ............ Bronchoscopy with biopsy. 3.37
31645.............. ............ Bronchoscopy, clear 3.16
airways.
32000.............. ............ Drainage of chest........ 1.54
32000.............. ............ Drainage of chest........ 1.54
32005.............. ............ Treat lung lining 2.19
chemically.
32020.............. ............ Insertion of chest tube.. 3.98
32035.............. ............ Exploration of chest..... 8.67
32095.............. ............ Biopsy through chest wall 8.36
32100.............. ............ Exploration/biopsy of 15.24
chest.
32110.............. ............ Explore/repair chest..... 23.00
32220.............. ............ Release of lung.......... 24.00
32225.............. ............ Partial release of lung.. 13.96
32320.............. ............ Free/remove chest lining. 24.00
32440.............. ............ Removal of lung.......... 25.00
32440.............. ............ Removal of lung.......... 25.00
32480.............. ............ Partial removal of lung.. 23.75
32480.............. ............ Partial removal of lung.. 23.75
32482.............. ............ Bilobectomy.............. 25.00
32491.............. ............ Lung volume reduction.... 21.25
32500.............. ............ Partial removal of lung.. 22.00
32520.............. ............ Remove lung & revise 21.68
chest.
32602.............. ............ Thoracoscopy, diagnostic. 5.96
32651.............. ............ Thoracoscopy, surgical... 12.91
32652.............. ............ Thoracoscopy, surgical... 18.66
32655.............. ............ Thoracoscopy, surgical... 13.10
32657.............. ............ Thoracoscopy, surgical... 13.65
33234.............. ............ Removal of pacemaker 7.82
system.
33235.............. ............ Removal of pacemaker 9.40
electrode.
33400.............. ............ Repair of aortic valve... 28.50
[[Page 31073]]
33405.............. ............ Replacement of aortic 35.00
valve.
33406.............. ............ Replacement of aortic 37.50
valve.
33410.............. ............ Replacement of aortic 32.46
valve.
33411.............. ............ Replacement of aortic 36.25
valve.
33412.............. ............ Replacement of aortic 42.00
valve.
33413.............. ............ Replacement of aortic 43.50
valve.
33415.............. ............ Revision, subvalvular 27.15
tissue.
33425.............. ............ Repair of mitral valve... 27.00
33426.............. ............ Repair of mitral valve... 33.00
33427.............. ............ Repair of mitral valve... 40.00
33430.............. ............ Replacement of mitral 33.50
valve.
33468.............. ............ Revision of tricuspid 30.12
valve.
33475.............. ............ Replacement, pulmonary 33.00
valve.
33506.............. ............ Repair artery, 35.50
translocation.
33510.............. ............ CABG, vein, single....... 29.00
33511.............. ............ CABG, vein, two.......... 30.00
33512.............. ............ CABG, vein, three........ 31.80
33513.............. ............ CABG, vein, four......... 32.00
33514.............. ............ CABG, vein, five......... 32.75
33516.............. ............ Cabg, vein, six or more.. 35.00
33517.............. ............ CABG, artery-vein, single 2.57
33518.............. ............ CABG, artery-vein, two... 4.85
33519.............. ............ CABG, artery-vein, three. 7.12
33521.............. ............ CABG, artery-vein, four.. 9.40
33522.............. ............ CABG, artery-vein, five.. 11.67
33523.............. ............ Cabg, art-vein, six or 13.95
more.
33530.............. ............ Coronary artery, bypass/ 5.86
reop.
33533.............. ............ CABG, arterial, single... 30.00
33534.............. ............ CABG, arterial, two...... 32.20
33535.............. ............ CABG, arterial, three.... 34.50
33536.............. ............ Cabg, arterial, four or 37.50
more.
33611.............. ............ Repair double ventricle.. 34.00
33612.............. ............ Repair double ventricle.. 35.00
33615.............. ............ Repair, simple fontan.... 34.00
33617.............. ............ Repair, modified fontan.. 37.00
33619.............. ............ Repair single ventricle.. 45.00
33641.............. ............ Repair heart septum 21.39
defect.
33660.............. ............ Repair of heart defects.. 30.00
33670.............. ............ Repair of heart chambers. 35.00
33681.............. ............ Repair heart septum 30.61
defect.
33694.............. ............ Repair of heart defects.. 34.00
33697.............. ............ Repair of heart defects.. 36.00
33730.............. ............ Repair heart-vein 34.25
defect(s).
33750.............. ............ Major vessel shunt....... 21.41
33767.............. ............ Major vessel shunt....... 24.50
33770.............. ............ Repair great vessels 37.00
defect.
33778.............. ............ Repair great vessels 40.00
defect.
33780.............. ............ Repair great vessels 41.75
defect.
33786.............. ............ Repair arterial trunk.... 39.00
33820.............. ............ Revise major vessel...... 16.29
33840.............. ............ Remove aorta constriction 20.63
33860.............. ............ Ascending aortic graft... 38.00
33861.............. ............ Ascending aortic graft... 42.00
33863.............. ............ Ascending aortic graft... 45.00
33870.............. ............ Transverse aortic arch 44.00
graft.
33875.............. ............ Thoracic aortic graft.... 33.06
33877.............. ............ Thoracoabdominal graft... 42.60
33917.............. ............ Repair pulmonary artery.. 24.50
33919.............. ............ Repair pulmonary atresia. 40.00
33945.............. ............ Transplantation of heart. 42.10
34101.............. ............ Removal of artery clot... 10.00
34111.............. ............ Removal of arm artery 10.00
clot.
34151.............. ............ Removal of artery clot... 25.00
34151.............. ............ Removal of artery clot... 25.00
34201.............. ............ Removal of artery clot... 10.03
34201.............. ............ Removal of artery clot... 10.03
[[Page 31074]]
34203.............. ............ Removal of leg artery 16.50
clot.
34203.............. ............ Removal of leg artery 16.50
clot.
34401.............. ............ Removal of vein clot..... 25.00
34401.............. ............ Removal of vein clot..... 25.00
34421.............. ............ Removal of vein clot..... 12.00
34421.............. ............ Removal of vein clot..... 12.00
34451.............. ............ Removal of vein clot..... 27.00
34451.............. ............ Removal of vein clot..... 27.00
34490.............. ............ Removal of vein clot..... 9.86
34501.............. ............ Repair valve, femoral 16.00
vein.
34510.............. ............ Transposition of vein 18.95
valve.
34520.............. ............ Cross-over vein graft.... 17.95
34530.............. ............ Leg vein fusion.......... 16.64
35011.............. ............ Repair defect of artery.. 18.00
35011.............. ............ Repair defect of artery.. 18.00
35013.............. ............ Repair artery rupture, 22.00
arm.
35013.............. ............ Repair artery rupture, 22.00
arm.
35045.............. ............ Repair defect of arm 17.57
artery.
35045.............. ............ Repair defect of arm 17.57
artery.
35081.............. ............ Repair defect of artery.. 28.01
35082.............. ............ Repair artery rupture, 38.50
aorta.
35082.............. ............ Repair artery rupture, 38.50
aorta.
35092.............. ............ Repair artery rupture, 45.00
aorta.
35092.............. ............ Repair artery rupture, 45.00
aorta.
35103.............. ............ Repair artery rupture, 40.50
groin.
35103.............. ............ Repair artery rupture, 40.50
groin.
35111.............. ............ Repair defect of artery.. 25.00
35111.............. ............ Repair defect of artery.. 25.00
35112.............. ............ Repair artery rupture, 30.00
spleen.
35112.............. ............ Repair artery rupture, 30.00
spleen.
35121.............. ............ Repair defect of artery.. 30.00
35121.............. ............ Repair defect of artery.. 30.00
35122.............. ............ Repair artery rupture, 35.00
belly.
35122.............. ............ Repair artery rupture, 35.00
belly.
35131.............. ............ Repair defect of artery.. 25.00
35131.............. ............ Repair defect of artery.. 25.00
35132.............. ............ Repair artery rupture, 30.00
groin.
35132.............. ............ Repair artery rupture, 30.00
groin.
35141.............. ............ Repair defect of artery.. 20.00
35141.............. ............ Repair defect of artery.. 20.00
35142.............. ............ Repair artery rupture, 23.30
thigh.
35142.............. ............ Repair artery rupture, 23.30
thigh.
35151.............. ............ Repair defect of artery.. 22.64
35151.............. ............ Repair defect of artery.. 22.64
35152.............. ............ Repair artery rupture, 25.62
knee.
35152.............. ............ Repair artery rupture, 25.62
knee.
35182.............. ............ Repair blood vessel 30.00
lesion.
35184.............. ............ Repair blood vessel 18.00
lesion.
35189.............. ............ Repair blood vessel 28.00
lesion.
35190.............. ............ Repair blood vessel 12.75
lesion.
35201.............. ............ Repair blood vessel 16.14
lesion.
35201.............. ............ Repair blood vessel 16.14
lesion.
35206.............. ............ Repair blood vessel 13.25
lesion.
35221.............. ............ Repair blood vessel 24.39
lesion.
35221.............. ............ Repair blood vessel 24.39
lesion.
35226.............. ............ Repair blood vessel 14.50
lesion.
35226.............. ............ Repair blood vessel 14.50
lesion.
35231.............. ............ Repair blood vessel 20.00
lesion.
35231.............. ............ Repair blood vessel 20.00
lesion.
35236.............. ............ Repair blood vessel 17.11
lesion.
35236.............. ............ Repair blood vessel 17.11
lesion.
35246.............. ............ Repair blood vessel 26.45
lesion.
35246.............. ............ Repair blood vessel 26.45
lesion.
35251.............. ............ Repair blood vessel 30.20
lesion.
35251.............. ............ Repair blood vessel 30.20
lesion.
35256.............. ............ Repair blood vessel 18.36
lesion.
[[Page 31075]]
35261.............. ............ Repair blood vessel 17.80
lesion.
35261.............. ............ Repair blood vessel 17.80
lesion.
35266.............. ............ Repair blood vessel 14.91
lesion.
35266.............. ............ Repair blood vessel 14.91
lesion.
35276.............. ............ Repair blood vessel 24.25
lesion.
35276.............. ............ Repair blood vessel 24.25
lesion.
35281.............. ............ Repair blood vessel 28.00
lesion.
35281.............. ............ Repair blood vessel 28.00
lesion.
35286.............. ............ Repair blood vessel 16.16
lesion.
35311.............. ............ Rechanneling of artery... 27.00
35311.............. ............ Rechanneling of artery... 27.00
35321.............. ............ Rechanneling of artery... 16.00
35321.............. ............ Rechanneling of artery... 16.00
35331.............. ............ Rechanneling of artery... 26.20
35331.............. ............ Rechanneling of artery... 26.20
35351.............. ............ Rechanneling of artery... 23.00
35351.............. ............ Rechanneling of artery... 23.00
35355.............. ............ Rechanneling of artery... 18.50
35355.............. ............ Rechanneling of artery... 18.50
35361.............. ............ Rechanneling of artery... 28.20
35361.............. ............ Rechanneling of artery... 28.20
35363.............. ............ Rechanneling of artery... 30.20
35363.............. ............ Rechanneling of artery... 30.20
35371.............. ............ Rechanneling of artery... 14.72
35371.............. ............ Rechanneling of artery... 14.72
35372.............. ............ Rechanneling of artery... 18.00
35372.............. ............ Rechanneling of artery... 18.00
35381.............. ............ Rechanneling of artery... 15.81
35511.............. ............ Artery bypass graft...... 21.20
35511.............. ............ Artery bypass graft...... 21.20
35518.............. ............ Artery bypass graft...... 21.20
35518.............. ............ Artery bypass graft...... 21.20
35521.............. ............ Artery bypass graft...... 22.20
35521.............. ............ Artery bypass graft...... 22.20
35526.............. ............ Artery bypass graft...... 29.95
35526.............. ............ Artery bypass graft...... 29.95
35531.............. ............ Artery bypass graft...... 36.20
35531.............. ............ Artery bypass graft...... 36.20
35533.............. ............ Artery bypass graft...... 28.00
35533.............. ............ Artery bypass graft...... 28.00
35536.............. ............ Artery bypass graft...... 31.70
35536.............. ............ Artery bypass graft...... 31.70
35541.............. ............ Artery bypass graft...... 25.80
35546.............. ............ Artery bypass graft...... 25.54
35551.............. ............ Artery bypass graft...... 26.67
35556.............. ............ Artery bypass graft...... 21.76
35556.............. ............ Artery bypass graft...... 21.76
35558.............. ............ Artery bypass graft...... 21.20
35558.............. ............ Artery bypass graft...... 21.20
35560.............. ............ Artery bypass graft...... 32.00
35560.............. ............ Artery bypass graft...... 32.00
35563.............. ............ Artery bypass graft...... 24.20
35563.............. ............ Artery bypass graft...... 24.20
35565.............. ............ Artery bypass graft...... 23.20
35565.............. ............ Artery bypass graft...... 23.20
35571.............. ............ Artery bypass graft...... 24.06
35571.............. ............ Artery bypass graft...... 24.06
35582.............. ............ Vein bypass graft........ 27.13
35587.............. ............ Vein bypass graft........ 24.75
35587.............. ............ Vein bypass graft........ 24.75
35621.............. ............ Artery bypass graft...... 20.00
35621.............. ............ Artery bypass graft...... 20.00
35623.............. ............ Bypass graft, not vein... 24.00
35623.............. ............ Bypass graft, not vein... 24.00
35626.............. ............ Artery bypass graft...... 27.75
35626.............. ............ Artery bypass graft...... 27.75
[[Page 31076]]
35631.............. ............ Artery bypass graft...... 34.00
35631.............. ............ Artery bypass graft...... 34.00
35636.............. ............ Artery bypass graft...... 29.50
35636.............. ............ Artery bypass graft...... 29.50
35641.............. ............ Artery bypass graft...... 24.57
35646.............. ............ Artery bypass graft...... 25.81
35650.............. ............ Artery bypass graft...... 19.00
35650.............. ............ Artery bypass graft...... 19.00
35654.............. ............ Artery bypass graft...... 25.00
35654.............. ............ Artery bypass graft...... 25.00
35661.............. ............ Artery bypass graft...... 19.00
35661.............. ............ Artery bypass graft...... 19.00
35663.............. ............ Artery bypass graft...... 22.00
35663.............. ............ Artery bypass graft...... 22.00
35665.............. ............ Artery bypass graft...... 21.00
35665.............. ............ Artery bypass graft...... 21.00
35666.............. ............ Artery bypass graft...... 22.19
35666.............. ............ Artery bypass graft...... 22.19
35671.............. ............ Artery bypass graft...... 19.33
35671.............. ............ Artery bypass graft...... 19.33
35701.............. ............ Exploration, carotid 8.50
artery.
35701.............. ............ Exploration, carotid 8.50
artery.
35721.............. ............ Exploration, femoral 7.18
artery.
35741.............. ............ Exploration popliteal 8.00
artery.
35840.............. ............ Explore abdominal vessels 9.77
35860.............. ............ Explore limb vessels..... 5.55
35905.............. ............ Excision, graft, thorax.. 31.25
35905.............. ............ Excision, graft, thorax.. 31.25
35907.............. ............ Excision, graft, abdomen. 35.00
35907.............. ............ Excision, graft, abdomen. 35.00
36400.............. ............ Drawing blood............ 0.18
36405.............. ............ Drawing blood............ 0.18
36406.............. ............ Drawing blood............ 0.18
36489.............. ............ Insertion of catheter, 2.50
vein.
36489.............. ............ Insertion of catheter, 2.50
vein.
36520.............. ............ Plasma and/or cell 1.74
exchange.
36533.............. ............ Insertion of access 5.32
device.
36534.............. ............ Revision of access device 2.80
36535.............. ............ Removal of access device. 2.27
36620.............. ............ Insertion catheter, 1.15
artery.
36625.............. ............ Insertion catheter, 2.11
artery.
36822.............. ............ Insertion of cannula(s).. 5.42
37565.............. ............ Ligation of neck vein.... 10.88
37565.............. ............ Ligation of neck vein.... 10.88
37600.............. ............ Ligation of neck artery.. 11.25
37600.............. ............ Ligation of neck artery.. 11.25
37605.............. ............ Ligation of neck artery.. 13.11
37605.............. ............ Ligation of neck artery.. 13.11
37609.............. ............ Temporal artery procedure 3.00
37609.............. ............ Temporal artery procedure 3.00
37615.............. ............ Ligation of neck artery.. 5.73
37615.............. ............ Ligation of neck artery.. 5.73
37617.............. ............ Ligation of abdomen 22.06
artery.
37618.............. ............ Ligation of extremity 4.84
artery.
37650.............. ............ Revision of major vein... 7.80
37660.............. ............ Revision of major vein... 21.00
37700.............. ............ Revise leg vein.......... 3.73
37720.............. ............ Removal of leg vein...... 5.66
37730.............. ............ Removal of leg veins..... 7.33
37735.............. ............ Removal of leg veins/ 10.53
lesion.
37760.............. ............ Revision of leg veins.... 10.47
37785.............. ............ Revision secondary 3.84
varicosity.
38100.............. ............ Removal of spleen, total. 14.50
38100.............. ............ Removal of spleen, total. 14.50
38101.............. ............ Removal of spleen, 15.31
partial.
38115.............. ............ Repair of ruptured spleen 15.82
[[Page 31077]]
38300.............. ............ Drainage, lymph node 1.99
lesion.
38305.............. ............ Drainage, lymph node 6.00
lesion.
38308.............. ............ Incision of lymph 6.45
channels.
38500.............. ............ Biopsy/removal, lymph 3.75
nodes.
38500.............. ............ Biopsy/removal, lymph 3.75
nodes.
38510.............. ............ Biopsy/removal, lymph 6.43
nodes.
38520.............. ............ Biopsy/removal, lymph 6.67
nodes.
38525.............. ............ Biopsy/removal, lymph 6.07
nodes.
38530.............. ............ Biopsy/removal, lymph 7.98
nodes.
38571.............. ............ Laparoscopy, 12.38
lymphadenectomy.
38572.............. ............ Laparoscopy, 16.59
lymphadenectomy.
38740.............. ............ Remove armpit lymph nodes 10.02
38745.............. ............ Remove armpit lymph nodes 13.00
38746.............. ............ Remove thoracic lymph 4.89
nodes.
38760.............. ............ Remove groin lymph nodes. 12.94
38765.............. ............ Remove groin lymph nodes. 19.98
38780.............. ............ Remove abdomen lymph 16.59
nodes.
39010.............. ............ Exploration of chest..... 11.79
39220.............. ............ Removal chest lesion..... 17.42
39400.............. ............ Visualization of chest... 5.61
39503.............. ............ Repair of diaphragm 34.85
hernia.
42205.............. ............ Reconstruct cleft palate. 13.29
43107.............. ............ Removal of esophagus..... 40.00
43112.............. ............ Removal of esophagus..... 43.50
43117.............. ............ Partial removal of 40.00
esophagus.
43122.............. ............ Parital removal of 40.00
esophagus.
43215.............. ............ Esophagus endoscopy...... 2.60
43217.............. ............ Esophagus endoscopy...... 2.90
43219.............. ............ Esophagus endoscopy...... 2.80
43228.............. ............ Esoph endoscopy, ablation 3.77
43239.............. ............ Upper GI endoscopy, 2.69
biopsy.
43239.............. ............ Upper GI endoscopy, 2.87
biopsy.
43244.............. ............ Upper GI endoscopy/ 4.59
ligation.
43246.............. ............ Place gastrostomy tube... 4.33
43246.............. ............ Place gastrostomy tube... 4.33
43247.............. ............ Operative upper GI 3.39
endoscopy.
43249.............. ............ Esoph endoscopy, dilation 2.90
43251.............. ............ Operative upper GI 3.70
endoscopy.
43255.............. ............ Operative upper GI 4.40
endoscopy.
43258.............. ............ Operative upper GI 4.55
endoscopy.
43259.............. ............ Endoscopic ultrasound 4.89
exam.
43263.............. ............ Endo 6.19
cholangiopancreatograph.
43265.............. ............ Endo 8.90
cholangiopancreatograph.
43269.............. ............ Endo 6.04
cholangiopancreatograph.
43310.............. ............ Repair of esophagus...... 25.39
43312.............. ............ Repair esophagus and 28.42
fistula.
43320.............. ............ Fuse esophagus & stomach. 19.93
43324.............. ............ Revise esophagus & 20.57
stomach.
43325.............. ............ Revise esophagus & 20.06
stomach.
43326.............. ............ Revise esophagus & 19.74
stomach.
43330.............. ............ Repair of esophagus...... 19.77
43331.............. ............ Repair of esophagus...... 20.13
43340.............. ............ Fuse esophagus & 19.61
intestine.
43341.............. ............ Fuse esophagus & 20.85
intestine.
43350.............. ............ Surgical opening, 15.78
esophagus.
43351.............. ............ Surgical opening, 18.35
esophagus.
43352.............. ............ Surgical opening, 15.26
esophagus.
43360.............. ............ Gastrointestinal repair.. 35.70
43361.............. ............ Gastrointestinal repair.. 40.50
43400.............. ............ Ligate esophagus veins... 21.20
43401.............. ............ Esophagus surgery for 22.09
veins.
43405.............. ............ Ligate/staple esophagus.. 20.01
43410.............. ............ Repair esophagus wound... 13.47
43415.............. ............ Repair esophagus wound... 25.00
43420.............. ............ Repair esophagus opening. 14.35
43425.............. ............ Repair esophagus opening. 21.03
[[Page 31078]]
43500.............. ............ Surgical opening of 11.05
stomach.
43501.............. ............ Surgical repair of 20.04
stomach.
43502.............. ............ Surgical repair of 23.13
stomach.
43510.............. ............ Surgical opening of 13.08
stomach.
43520.............. ............ Incision of pyloric 9.99
muscle.
43605.............. ............ Biopsy of stomach........ 11.98
43610.............. ............ Excision of stomach 14.60
lesion.
43611.............. ............ Excision of stomach 17.84
lesion.
43620.............. ............ Removal of stomach....... 30.04
43621.............. ............ Removal of stomach....... 30.73
43622.............. ............ Removal of stomach....... 32.53
43631.............. ............ Removal of stomach, 22.59
partial.
43632.............. ............ Removal of stomach, 22.59
partial.
43633.............. ............ Removal of stomach, 23.10
partial.
43634.............. ............ Removal of stomach, 25.12
partial.
43638.............. ............ Removal of stomach, 29.00
partial.
43638.............. ............ Removal of stomach, 29.00
partial.
43639.............. ............ Removal of stomach, 29.65
partial.
43640.............. ............ Vagotomy & pylorus repair 17.02
43641.............. ............ Vagotomy & pylorus repair 17.27
43651.............. ............ Laparoscopy, vagus nerve. 10.15
43652.............. ............ Laparoscopy, vagus nerve. 12.15
43800.............. ............ Reconstruction of pylorus 13.69
43810.............. ............ Fusion of stomach and 14.65
bowel.
43820.............. ............ Fusion of stomach and 15.37
bowel.
43825.............. ............ Fusion of stomach and 19.22
bowel.
43830.............. ............ Place gastrostomy tube... 9.53
43832.............. ............ Place gastrostomy tube... 15.60
43840.............. ............ Repair of stomach lesion. 15.56
43842.............. ............ Gastroplasty for obesity. 18.47
43843.............. ............ Gastroplasty for obesity. 18.65
43846.............. ............ Gastric bypass for 24.05
obesity.
43847.............. ............ Gastric bypass for 26.92
obesity.
43848.............. ............ Revision gastroplasty.... 29.39
43850.............. ............ Revise stomach-bowel 24.72
fusion.
43855.............. ............ Revise stomach-bowel 26.16
fusion.
43860.............. ............ Revise stomach-bowel 25.00
fusion.
43865.............. ............ Revise stomach-bowel 26.52
fusion.
43870.............. ............ Repair stomach opening... 9.69
43880.............. ............ Repair stomach-bowel 24.65
fistula.
44005.............. ............ Freeing of bowel adhesion 16.23
44010.............. ............ Incision of small bowel.. 12.52
44020.............. ............ Exploration of small 13.99
bowel.
44021.............. ............ Decompress small bowel... 14.08
44025.............. ............ Incision of large bowel.. 14.28
44050.............. ............ Reduce bowel obstruction. 14.03
44050.............. ............ Reduce bowel obstruction. 14.03
44055.............. ............ Correct malrotation of 22.00
bowel.
44110.............. ............ Excision of bowel 11.81
lesion(s).
44111.............. ............ Excision of bowel 14.29
lesion(s).
44120.............. ............ Removal of small 17.00
intestine.
44125.............. ............ Removal of small 17.54
intestine.
44130.............. ............ Bowel to bowel fusion.... 14.49
44130.............. ............ Bowel to bowel fusion.... 14.49
44140.............. ............ Partial removal of colon. 21.00
44140.............. ............ Partial removal of colon. 21.00
44143.............. ............ Partial removal of colon. 22.99
44144.............. ............ Partial removal of colon. 21.53
44144.............. ............ Partial removal of colon. 21.53
44145.............. ............ Partial removal of colon. 26.42
44146.............. ............ Partial removal of colon. 27.54
44147.............. ............ Partial removal of colon. 20.71
44150.............. ............ Removal of colon......... 23.95
44151.............. ............ Removal of colon/ 26.88
ileostomy.
44151.............. ............ Removal of colon/ 26.88
ileostomy.
44152.............. ............ Removal of colon/ 27.83
ileostomy.
[[Page 31079]]
44153.............. ............ Removal of colon/ 30.59
ileostomy.
44155.............. ............ Removal of colon/ 27.86
ileostomy.
44156.............. ............ Removal of colon/ 30.79
ileostomy.
44156.............. ............ Removal of colon/ 30.79
ileostomy.
44160.............. ............ Removal of colon......... 18.62
44200.............. ............ Laparoscopy, enterolysis. 14.44
44300.............. ............ Open bowel to skin....... 12.11
44310.............. ............ Ileostomy/jejunostomy.... 15.95
44312.............. ............ Revision of ileostomy.... 8.02
44314.............. ............ Revision of ileostomy.... 15.05
44316.............. ............ Devise bowel pouch....... 21.09
44320.............. ............ Colostomy................ 17.64
44340.............. ............ Revision of colostomy.... 7.72
44345.............. ............ Revision of colostomy.... 15.43
44346.............. ............ Revision of colostomy.... 16.99
44388.............. ............ Colon endoscopy.......... 2.82
44389.............. ............ Colonoscopy with biopsy.. 3.13
44390.............. ............ Colonoscopy for foreign 3.83
body.
44391.............. ............ Colonoscopy for bleeding. 4.32
44392.............. ............ Colonoscopy and 3.82
polypectomy.
44393.............. ............ Colonoscopy, lesion 4.84
removal.
44394.............. ............ Colonoscopy w/snare...... 4.43
44394.............. ............ Colonoscopy w/snare...... 4.43
44602.............. ............ Suture, small intestine.. 16.03
44603.............. ............ Suture, small intestine.. 18.66
44604.............. ............ Suture, large intestine.. 16.03
44605.............. ............ Repair of bowel lesion... 19.53
44615.............. ............ Intestinal 15.93
stricturoplasty.
44620.............. ............ Repair bowel opening..... 12.20
44625.............. ............ Repair bowel opening..... 15.05
44626.............. ............ Repair bowel opening..... 25.36
44640.............. ............ Repair bowel-skin fistula 21.65
44650.............. ............ Repair bowel fistula..... 22.57
44660.............. ............ Repair bowel-bladder 21.36
fistula.
44661.............. ............ Repair bowel-bladder 24.81
fistula.
44680.............. ............ Surgical revision, 15.40
intestine.
44700.............. ............ Suspend bowel w/ 16.11
prosthesis.
44800.............. ............ Excision of bowel pouch.. 11.23
44820.............. ............ Excision of mesentery 12.09
lesion.
44850.............. ............ Repair of mesentery...... 10.74
44900.............. ............ Drain app abscess, open.. 10.14
44950.............. ............ Appendectomy............. 10.00
44960.............. ............ Appendectomy............. 12.34
44970.............. ............ Laparoscopy, appendectomy 8.70
45000.............. ............ Drainage of pelvic 4.52
abscess.
45020.............. ............ Drainage of rectal 4.72
abscess.
45100.............. ............ Biopsy of rectum......... 3.68
45108.............. ............ Removal of anorectal 4.76
lesion.
45110.............. ............ Removal of rectum........ 28.00
45111.............. ............ Partial removal of rectum 16.48
45112.............. ............ Removal of rectum........ 30.54
45113.............. ............ Partial proctectomy...... 30.58
45114.............. ............ Partial removal of rectum 27.32
45116.............. ............ Partial removal of rectum 24.58
45119.............. ............ Remove rectum w/reservoir 30.84
45120.............. ............ Removal of rectum........ 24.60
45121.............. ............ Removal of rectum and 27.04
colon.
45123.............. ............ Partial proctectomy...... 16.71
45126.............. ............ Pelvic exenteration...... 45.16
45130.............. ............ Excision of rectal 16.44
prolapse.
45135.............. ............ Excision of rectal 19.28
prolapse.
45160.............. ............ Excision of rectal lesion 15.32
45170.............. ............ Excision of rectal lesion 11.49
45190.............. ............ Destruction, rectal tumor 9.74
45305.............. ............ Proctosigmoidoscopy & 1.01
biopsy.
45309.............. ............ Proctosigmoidoscopy...... 2.01
[[Page 31080]]
45330.............. ............ Diagnostic sigmoidoscopy. 0.96
45337.............. ............ Sigmoidoscopy & 2.36
decompress.
45339.............. ............ Sigmoidoscopy............ 3.14
45378.............. ............ Diagnostic colonoscopy... 3.70
45380.............. ............ Colonoscopy and biopsy... 4.01
45383.............. ............ Lesion removal 5.87
colonoscopy.
45384.............. ............ Colonoscopy.............. 4.70
45385.............. ............ Lesion removal 5.31
colonoscopy.
45505.............. ............ Repair of rectum......... 7.58
45540.............. ............ Correct rectal prolapse.. 16.27
45541.............. ............ Correct rectal prolapse.. 13.40
45550.............. ............ Repair rectum/remove 23.00
sigmoid.
45560.............. ............ Repair of rectocele...... 10.58
45562.............. ............ Exploration/repair of 15.38
rectum.
45563.............. ............ Exploration/repair of 23.47
rectum.
45800.............. ............ Repair rect/bladder 17.77
fistula.
45805.............. ............ Repair fistula w/ 20.78
colostomy.
45820.............. ............ Repair rectourethral 18.48
fistula.
45825.............. ............ Repair fistula w/ 21.25
colostomy.
45900.............. ............ Reduction of rectal 2.61
prolapse.
45905.............. ............ Dilation of anal 2.30
sphincter.
45910.............. ............ Dilation of rectal 2.80
narrowing.
45910.............. ............ Dilation of rectal 2.80
narrowing.
45915.............. ............ Remove rectal obstruction 3.14
46040.............. ............ Incision of rectal 4.96
abscess.
46045.............. ............ Incision of rectal 4.32
abscess.
46060.............. ............ Incision of rectal 5.69
abscess.
46083.............. ............ Incise external 1.40
hemorrhoid.
46083.............. ............ Incise external 1.40
hemorrhoid.
46221.............. ............ Ligation of hemorrhoid(s) 2.04
46230.............. ............ Removal of anal tabs..... 2.57
46250.............. ............ Hemorrhoidectomy......... 3.89
46255.............. ............ Hemorrhoidectomy......... 4.60
46257.............. ............ Remove hemorrhoids & 5.40
fissure.
46258.............. ............ Remove hemorrhoids & 5.73
fistula.
46258.............. ............ Remove hemorrhoids & 5.73
fistula.
46260.............. ............ Hemorrhoidectomy......... 6.37
46261.............. ............ Remove hemorrhoids & 7.08
fissure.
46262.............. ............ Remove hemorrhoids & 7.50
fistula.
46270.............. ............ Removal of anal fistula.. 3.72
46275.............. ............ Removal of anal fistula.. 4.56
46280.............. ............ Removal of anal fistula.. 5.98
46288.............. ............ Repair anal fistula...... 7.13
46320.............. ............ Removal of hemorrhoid 1.61
clot.
46320.............. ............ Removal of hemorrhoid 1.61
clot.
46700.............. ............ Repair of anal stricture. 9.13
46705.............. ............ Repair of anal stricture. 6.90
46715.............. ............ Repair of anovaginal 7.20
fistula.
46716.............. ............ Repair of anovaginal 15.07
fistula.
46730.............. ............ Construction of absent 26.75
anus.
46735.............. ............ Construction of absent 32.17
anus.
46740.............. ............ Construction of absent 30.00
anus.
46742.............. ............ Repair of imperforated 35.80
anus.
46744.............. ............ Repair of cloacal anomaly 52.63
46746.............. ............ Repair of cloacal anomaly 58.22
46748.............. ............ Repair of cloacal anomaly 64.21
46750.............. ............ Repair of anal sphincter. 10.25
46753.............. ............ Reconstruction of anus... 8.29
46754.............. ............ Removal of suture from 2.20
anus.
46760.............. ............ Repair of anal sphincter. 14.43
46761.............. ............ Repair of anal sphincter. 13.84
46762.............. ............ Implant artificial 12.71
sphincter.
46900.............. ............ Destruction, anal 1.91
lesion(s).
46910.............. ............ Destruction, anal 1.86
lesion(s).
46916.............. ............ Cryosurgery, anal 1.86
lesion(s).
46917.............. ............ Laser surgery, anal 1.86
lesions.
[[Page 31081]]
46922.............. ............ Excision of anal 1.86
lesion(s).
46924.............. ............ Destruction, anal 2.76
lesion(s).
46924.............. ............ Destruction, anal 2.76
lesion(s).
46934.............. ............ Destruction of 3.51
hemorrhoids.
46935.............. ............ Destruction of 2.43
hemorrhoids.
46936.............. ............ Destruction of 3.69
hemorrhoids.
46940.............. ............ Treatment of anal fissure 2.32
46942.............. ............ Treatment of anal fissure 2.04
46945.............. ............ Ligation of hemorrhoids.. 1.84
46946.............. ............ Ligation of hemorrhoids.. 2.58
47010.............. ............ Open drainage, liver 16.01
lesion.
47015.............. ............ Inject/aspirate liver 15.11
cyst.
47100.............. ............ Wedge biopsy of liver.... 11.67
47120.............. ............ Partial removal of liver. 35.50
47122.............. ............ Extensive removal of 55.13
liver.
47125.............. ............ Partial removal of liver. 49.19
47130.............. ............ Partial removal of liver. 53.35
47134.............. ............ Partial removal, donor 39.15
liver.
47300.............. ............ Surgery for liver lesion. 15.08
47350.............. ............ Repair liver wound....... 19.56
47360.............. ............ Repair liver wound....... 26.92
47361.............. ............ Repair liver wound....... 47.12
47362.............. ............ Repair liver wound....... 18.51
47400.............. ............ Incision of liver duct... 32.49
47420.............. ............ Incision of bile duct.... 19.88
47425.............. ............ Incision of bile duct.... 19.83
47460.............. ............ Incise bile duct 18.04
sphincter.
47480.............. ............ Incision of gallbladder.. 10.82
47562.............. ............ Laparoscopic 11.09
cholecystectomy.
47563.............. ............ Laparoscopic 11.94
cholecystectomy.
47564.............. ............ Laparo cholecystectomy/ 14.23
explr.
47570.............. ............ Laparo 12.58
cholecystoenterostomy.
47600.............. ............ Removal of gallbladder... 13.58
47605.............. ............ Removal of gallbladder... 14.69
47610.............. ............ Removal of gallbladder... 18.82
47612.............. ............ Removal of gallbladder... 18.78
47620.............. ............ Removal of gallbladder... 20.64
47701.............. ............ Bile duct revision....... 27.81
47711.............. ............ Excision of bile duct 23.03
tumor.
47712.............. ............ Excision of bile duct 30.24
tumor.
47715.............. ............ Excision of bile duct 18.80
cyst.
47716.............. ............ Fusion of bile duct cyst. 16.44
47720.............. ............ Fuse gallbladder & bowel. 15.91
47721.............. ............ Fuse upper gi structures. 19.12
47740.............. ............ Fuse gallbladder & bowel. 18.48
47741.............. ............ Fuse gallbladder & bowel. 21.34
47760.............. ............ Fuse bile ducts and bowel 25.85
47765.............. ............ Fuse liver ducts & bowel. 24.88
47780.............. ............ Fuse bile ducts and bowel 26.50
47785.............. ............ Fuse bile ducts and bowel 31.18
47800.............. ............ Reconstruction of bile 23.30
ducts.
47801.............. ............ Placement, bile duct 15.17
support.
47802.............. ............ Fuse liver duct & 21.55
intestine.
47900.............. ............ Suture bile duct injury.. 19.90
48000.............. ............ Drainage of abdomen...... 28.07
48001.............. ............ Placement of drain, 35.45
pancreas.
48005.............. ............ Resect/debride pancreas.. 42.17
48020.............. ............ Removal of pancreatic 15.70
stone.
48100.............. ............ Biopsy of pancreas....... 12.23
48120.............. ............ Removal of pancreas 15.85
lesion.
48140.............. ............ Partial removal of 22.94
pancreas.
48145.............. ............ Partial removal of 24.02
pancreas.
48146.............. ............ Pancreatectomy........... 26.40
48148.............. ............ Removal of pancreatic 17.34
duct.
48150.............. ............ Partial removal of 48.00
pancreas.
48150.............. ............ Partial removal of 48.00
pancreas.
[[Page 31082]]
48152.............. ............ Pancreatectomy........... 43.75
48153.............. ............ Pancreatectomy........... 47.89
48154.............. ............ Pancreatectomy........... 44.10
48155.............. ............ Removal of pancreas...... 24.64
48180.............. ............ Fuse pancreas and bowel.. 24.72
48500.............. ............ Surgery of pancreas cyst. 15.28
48510.............. ............ Drain pancreatic 14.31
pseudocyst.
48520.............. ............ Fuse pancreas cyst and 15.59
bowel.
48540.............. ............ Fuse pancreas cyst and 19.72
bowel.
48545.............. ............ Pancreatorrhaphy......... 18.18
48547.............. ............ Duodenal exclusion....... 25.83
49000.............. ............ Exploration of abdomen... 11.68
49002.............. ............ Reopening of abdomen..... 10.49
49010.............. ............ Exploration behind 12.28
abdomen.
49020.............. ............ Drain abdominal abscess.. 22.84
49040.............. ............ Drain, open, abdom 13.52
abscess.
49060.............. ............ Drain, open, retrop 15.86
abscess.
49085.............. ............ Remove abdomen foreign 12.14
body.
49200.............. ............ Removal of abdominal 10.25
lesion.
49201.............. ............ Removal of abdominal 14.84
lesion.
49215.............. ............ Excise sacral spine tumor 33.50
49215.............. ............ Excise sacral spine tumor 33.50
49220.............. ............ Multiple surgery, abdomen 14.88
49255.............. ............ Removal of omentum....... 11.14
49320.............. ............ Diag laparo separate proc 5.10
49321.............. ............ Laparoscopy; biopsy...... 5.40
49322.............. ............ Laparoscopy; aspiration.. 5.70
49421.............. ............ Insert abdominal drain... 5.54
49422.............. ............ Remove perm cannula/ 6.25
catheter.
49425.............. ............ Insert abdomen-venous 11.37
drain.
49426.............. ............ Revise abdomen-venous 9.63
shunt.
49428.............. ............ Ligation of shunt........ 6.06
49429.............. ............ Removal of shunt......... 7.40
49495.............. ............ Repair inguinal hernia, 5.89
init.
49495.............. ............ Repair inguinal hernia, 5.89
init.
49496.............. ............ Repair inguinal hernia, 8.79
init.
49496.............. ............ Repair inguinal hernia, 8.79
init.
49500.............. ............ Repair inguinal hernia... 5.48
49501.............. ............ Repair inguinal hernia, 8.88
init.
49505.............. ............ Repair inguinal hernia... 7.60
49505.............. ............ Repair inguinal hernia... 7.60
49507.............. ............ Repair inguinal hernia... 9.57
49520.............. ............ Rerepair inguinal hernia. 9.63
49521.............. ............ Repair inguinal hernia, 11.97
rec.
49525.............. ............ Repair inguinal hernia... 8.57
49540.............. ............ Repair lumbar hernia..... 10.39
49550.............. ............ Repair femoral hernia.... 8.63
49553.............. ............ Repair femoral hernia, 9.44
init.
49555.............. ............ Repair femoral hernia.... 9.03
49557.............. ............ Repair femoral hernia, 11.15
recur.
49560.............. ............ Repair abdominal hernia.. 11.57
49561.............. ............ Repair incisional hernia. 14.25
49565.............. ............ Rerepair abdominal hernia 11.57
49566.............. ............ Repair incisional hernia. 14.40
49570.............. ............ Repair epigastric hernia. 5.69
49572.............. ............ Repair epigastric hernia. 6.73
49580.............. ............ Repair umbilical hernia.. 4.11
49582.............. ............ Repair umbilical hernia.. 6.65
49585.............. ............ Repair umbilical hernia.. 6.23
49587.............. ............ Repair umbilical hernia.. 7.56
49590.............. ............ Repair abdominal hernia.. 8.54
49605.............. ............ Repair umbilical lesion.. 22.66
49606.............. ............ Repair umbilical lesion.. 18.60
49650.............. ............ Laparo hernia repair 6.27
initial.
49651.............. ............ Laparo hernia repair 8.24
recur.
49900.............. ............ Repair of abdominal wall. 12.28
[[Page 31083]]
49905.............. ............ Omental flap............. 6.55
50200.............. ............ Biopsy of kidney......... 2.63
50230.............. ............ Removal of kidney........ 22.07
51595.............. ............ Remove bladder/revise 37.14
tract.
51596.............. ............ Remove bladder/create 39.52
pouch.
56515.............. ............ Destruction, vulva 2.76
lesion(s).
56740.............. ............ Remove vagina gland 4.57
lesion.
57100.............. ............ Biopsy of vagina......... 1.20
57130.............. ............ Remove vagina lesion..... 2.43
57292.............. ............ Construct vagina with 13.09
graft.
57307.............. ............ Fistula repair & 15.93
colostomy.
57410.............. ............ Pelvic examination....... 1.75
57505.............. ............ Endocervical curettage... 1.14
58150.............. ............ Total hysterectomy....... 15.24
58152.............. ............ Total hysterectomy....... 20.60
58260.............. ............ Vaginal hysterectomy..... 12.98
58262.............. ............ Vaginal hysterectomy..... 14.77
58263.............. ............ Vaginal hysterectomy..... 16.06
58267.............. ............ Hysterectomy & vagina 17.04
repair.
58270.............. ............ Hysterectomy & vagina 14.26
repair.
58275.............. ............ Hysterectomy/revise 15.76
vagina.
58280.............. ............ Hysterectomy/revise 17.01
vagina.
58285.............. ............ Extensive hysterectomy... 22.26
58323.............. ............ Sperm washing............ 0.23
58400.............. ............ Suspension of uterus..... 6.36
58600.............. ............ Division of fallopian 5.60
tube.
58605.............. ............ Division of fallopian 5.00
tube.
58611.............. ............ Ligate oviduct(s) add-on. 1.45
58700.............. ............ Removal of fallopian tube 12.05
58740.............. ............ Revise fallopian tube(s). 14.00
58805.............. ............ Drainage of ovarian 5.88
cyst(s).
58820.............. ............ Drain ovary abscess, open 4.22
58825.............. ............ Transposition, ovary(s).. 10.98
58920.............. ............ Partial removal of 11.36
ovary(s).
58950.............. ............ Resect ovarian malignancy 16.93
58951.............. ............ Resect ovarian malignancy 22.38
59150.............. ............ Treat ectopic pregnancy.. 11.67
59151.............. ............ Treat ectopic pregnancy.. 11.49
59812.............. ............ Treatment of miscarriage. 4.01
59870.............. ............ Evacuate mole of uterus.. 6.01
60100.............. ............ Biopsy of thyroid........ 1.56
60220.............. ............ Partial removal of 11.90
thyroid.
60220.............. ............ Partial removal of 11.90
thyroid.
60252.............. ............ Removal of thyroid....... 20.57
60254.............. ............ Extensive thyroid surgery 26.99
60260.............. ............ Repeat thyroid surgery... 17.47
60270.............. ............ Removal of thyroid....... 20.27
60271.............. ............ Removal of thyroid....... 16.83
60540.............. ............ Explore adrenal gland.... 17.03
60545.............. ............ Explore adrenal gland.... 19.88
62263.............. ............ Lysis epidural adhesions. 6.14
62310.............. ............ Inject spine c/t......... 1.91
62311.............. ............ Inject spine l/s (cd).... 1.54
62318.............. ............ Inject spine w/cath, c/t. 2.04
62319.............. ............ Inject spine w/cath l/s 1.87
(cd).
65855.............. ............ Laser surgery of eye..... 3.85
66180.............. ............ Implant eye shunt........ 14.55
66986.............. ............ Exchange lens prosthesis. 12.28
67028.............. ............ Injection eye drug....... 2.52
67218.............. ............ Treatment of retinal 18.53
lesion.
67904.............. ............ Repair eyelid defect..... 6.26
69990.............. ............ Microsurgery add-on...... 3.47
72275.............. ............ Epidurography............ 0.76
76005.............. ............ Fluoroguide for spine 0.60
inject.
76065.............. ............ X-rays, bone evaluation.. 0.70
76090.............. ............ Mammogram, one breast.... 0.70
[[Page 31084]]
76091.............. ............ Mammogram, both breasts.. 0.87
76095.............. ............ Stereotactic breast 1.59
biopsy.
88170.............. ............ Fine needle aspiration... 1.27
88171.............. ............ Fine needle aspiration... 1.27
90901.............. ............ Biofeedback train, any 0.41
meth.
90911.............. ............ Biofeedback peri/uro/ 0.89
rectal.
90935.............. ............ Hemodialysis, one 1.22
evaluation.
90937.............. ............ Hemodialysis, repeated 2.11
eval.
90945.............. ............ Dialysis, one evaluation. 1.28
90947.............. ............ Dialysis, repeated eval.. 2.16
90989.............. ............ Dialysis training, 0.00
complete.
90993.............. ............ Dialysis training, 0.00
incompl.
90997.............. ............ Hemoperfusion............ 1.84
92018.............. ............ New eye exam & treatment. 2.50
93350.............. ............ Echo transthoracic....... 1.48
94640.............. ............ Airway inhalation 0.00
treatment.
94664.............. ............ Aerosol or vapor 0.00
inhalations.
94665.............. ............ Aerosol or vapor 0.00
inhalations.
96100.............. ............ Psychological testing.... 0.00
96105.............. ............ Assessment of aphasia.... 0.00
96110.............. ............ Developmental test, lim.. 0.00
96115.............. ............ Neurobehavior status exam 0.00
96117.............. ............ Neuropsych test battery.. 0.00
97542.............. ............ Wheelchair mngmnt 0.45
training.
99233.............. ............ Subsequent hospital care. 1.51
99273.............. ............ Confirmatory consultation 1.19
99274.............. ............ Confirmatory consultation 1.73
99291.............. ............ Critical care, first hour 4.00
99291.............. ............ Critical care, first hour 4.00
99291.............. ............ Critical care, first hour 4.00
99292.............. ............ Critical care, addl 30 2.00
min.
99292.............. ............ Critical care, addl 30 2.00
min.
99292.............. ............ Critical care, addl 30 2.00
min.
99295.............. ............ Neonatal critical care... 16.00
99296.............. ............ Neonatal critical care... 8.00
99297.............. ............ Neonatal critical care... 4.00
99298.............. ............ Neonatal critical care... 2.75
99436.............. ............ Attendance, birth........ 1.50
99440.............. ............ Newborn resuscitation.... 2.93
------------------------------------------------------------------------
\1\All CPT codes and descriptors copyright 2000 American Medical
Association
Federal Register / Vol. 66, No. 111 / Friday, June 8, 2001 /
Notices
[[Page 31084]]
[FR Doc. 01-14336 Filed 6-7-01; 8:45 am]
BILLING CODE 4120-01-P