Medicare Program; Five-Year Review of Work Relative Value Units Under the Physician Fee Schedule
Federal RegisterJun 8, 2001
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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.
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
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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
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)
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.
——————————
1
All CPT codes and descriptors copyright 2000 American Medical Association
Table 1.—Five-Year Review of Work Relative Value Units
CPT/HCPCS
code
1
Mod
Descriptor
2000
work RVU
Requested
work RVU
RUC
REC
HCPAC
REC
HCFA
decision
Proposed
work RVU
11055
Trim skin lesion
0.27
0.43
(a)
(a)
0.27
11056
Trim skin lesion, 2 to 4
0.39
0.61
(a)
(a)
0.39
11057
Trim skin lesions, over 4
0.50
0.79
(a)
(a)
0.50
11100
Biopsy of skin lesion
0.81
WD
(e)
(a)
0.81
11402
Removal of skin lesion
1.61
2.20
1.61
agree
1.61
11642
Removal of skin lesion
2.93
3.05
2.93
agree
2.93
11642
Removal of skin lesion
2.93
3.87
2.93
agree
2.93
11719
Trim nail(s)
0.11
0.17
(a)
(a)
0.11
11730
Removal of nail plate
1.13
WD
(e)
(a)
1.13
12001
Repair superficial wound(s)
1.70
N/A
CPT
CPT
1.70
12002
Repair superficial wound(s)
1.86
N/A
CPT
CPT
1.86
12011
Repair superficial wound(s)
1.76
2.37
1.76
agree
1.76
13101
Repair of wound or lesion
3.92
5.43
3.92
agree
3.92
13131
Repair of wound or lesion
3.79
4.79
3.79
agree
3.79
13132
Repair of wound or lesion
5.95
6.95
5.95
agree
5.95
15000
Skin graft
4.00
5.95
CPT
CPT
4.00
15001
Skin graft add-on
1.00
2.50
CPT
CPT
1.00
15100
Skin split graft
9.05
9.05
CPT
CPT
9.05
15101
Skin split graft add-on
1.72
1.72
CPT
CPT
1.72
15120
Skin split graft
9.83
9.83
CPT
CPT
9.83
15121
Skin split graft add-on
2.67
2.67
CPT
CPT
2.67
15350
Skin homograft
4.00
4.00
CPT
CPT
4.00
15351
Skin homograft add-on
1.00
1.00
CPT
CPT
1.00
15400
Skin heterograft
4.00
4.00
CPT
CPT
4.00
15401
Skin heterograft add-on
1.00
1.00
CPT
CPT
1.00
17000
Destroy benign/premal lesion
0.60
WD
(e)
(a)
0.60
17003
Destroy lesions, 2-14
0.15
WD
(e)
(a)
0.15
17004
Destroy lesions, 15 or more
2.79
WD
(e)
(a)
2.79
19000
Drainage of breast lesion
0.84
1.27
0.84
agree
0.84
19100
Biopsy of breast
1.27
3.88
1.27
agree
1.27
19125
Excision, breast lesion
6.06
9.00
6.06
agree
6.06
19160
Removal of breast tissue
5.99
8.38
5.99
agree
5.99
19162
Remove breast tissue, nodes
13.53
15.68
13.53
agree
13.53
19240
Removal of breast
16.00
18.87
16.00
agree
16.00
20205
Deep muscle biopsy
2.35
3.42
CPT
CPT
2.35
20245
Bone biopsy, excisional
3.95
7.97
8.50
decrease
7.78
20600
Drain/inject, joint/bursa
0.66
WD
(e)
(a)
0.66
20605
Drain/inject, joint/bursa
0.68
WD
(e)
(a)
0.68
21740
Reconstruction of sternum
16.50
21.00
CPT
CPT
16.50
21800
Treatment of rib fracture
0.96
1.77
0.96
agree
0.96
23076
Removal of shoulder lesion
7.63
13.40
CPT
CPT
7.63
23472
Reconstruct shoulder joint
16.92
21.27
21.10
agree
21.10
23485
Revision of collar bone
13.43
18.73
13.43
agree
13.43
23585
Treat scapula fracture
8.96
11.46
8.96
agree
8.96
23615
Treat humerus fracture
9.35
15.85
9.35
agree
9.35
23630
Treat humerus fracture
7.35
12.45
7.35
agree
7.35
23680
Treat dislocation/fracture
10.06
13.10
10.06
agree
10.06
24076
Remove arm/elbow lesion
6.30
10.20
CPT
CPT
6.30
24435
Repair humerus with graft
13.17
20.36
13.17
agree
13.17
24545
Treat humerus fracture
10.46
12.26
10.46
agree
10.46
25076
Removal of forearm lesion
4.92
12.96
CPT
CPT
4.92
26562
Repair of web finger
9.68
12.56
15.00
agree
15.00
27048
Remove hip/pelvis lesion
6.25
13.01
CPT
CPT
6.25
27075
Extensive hip surgery
17.23
28.52
35.00
agree
35.00
27077
Extensive hip surgery
23.13
30.00
40.00
agree
40.00
27216
Treat pelvic ring fracture
15.19
25.00
15.19
agree
15.19
27217
Treat pelvic ring fracture
14.11
17.11
14.11
agree
14.11
27218
Treat pelvic ring fracture
20.15
22.15
20.15
agree
20.15
27226
Treat hip wall fracture
14.91
19.91
14.91
agree
14.91
27236
Treat thigh fracture
15.60
17.60
15.60
agree
15.60
27280
Fusion of sacroiliac joint
13.39
21.00
13.39
agree
13.39
27282
Fusion of pubic bones
11.34
21.66
11.34
agree
11.34
27284
Fusion of hip joint
16.76
20.12
23.45
agree
23.45
27328
Removal of thigh lesion
5.57
8.70
CPT
CPT
5.57
27472
Repair/graft of thigh
17.72
23.62
17.72
agree
17.72
27513
Treatment of thigh fracture
17.92
20.92
17.92
agree
17.92
27536
Treat knee fracture
15.65
19.00
15.65
agree
15.65
27590
Amputate leg at thigh
12.03
15.52
12.03
agree
12.03
27619
Remove lower leg lesion
8.40
10.02
CPT
CPT
8.40
27724
Repair/graft of tibia
14.99
19.34
18.20
agree
18.20
27822
Treatment of ankle fracture
9.20
10.68
11.00
agree
11.00
27823
Treatment of ankle fracture
11.80
13.27
13.00
agree
13.00
27828
Treat lower leg fracture
16.23
19.00
16.23
agree
16.23
28299
Correction of bunion
8.88
11.90
9.18
agree
9.18
28322
Repair of metatarsals
8.34
13.26
8.34
agree
8.34
28420
Treat/graft heel fracture
16.64
23.52
16.64
agree
16.64
28445
Treat ankle fracture
9.33
15.97
15.62
agree
15.62
28705
Fusion of foot bones
15.21
20.46
18.80
agree
18.80
29450
Application of leg cast
1.02
3.00
2.08
agree
2.08
29450
Application of leg cast
1.02
N/A
2.08
agree
2.08
29881
Knee arthroscopy/surgery
7.76
WD
(e)
(a)
7.76
29883
Knee arthroscopy/surgery
9.46
12.00
11.05
agree
11.05
29889
Knee arthroscopy/surgery
15.13
16.68
16.00
agree
16.00
29889
Knee arthroscopy/surgery
15.13
18.47
16.00
agree
16.00
31600
Incision of windpipe
3.62
6.42
7.18
agree
7.18
31622
Dx bronchoscope/wash
2.78
4.17
2.78
agree
2.78
31622
Dx bronchoscope/wash
2.78
N/A
2.78
agree
2.78
31625
Bronchoscopy with biopsy
3.37
N/A
3.37
agree
3.37
31645
Bronchoscopy, clear airways
3.16
N/A
3.16
agree
3.16
32000
Drainage of chest
1.54
2.88
1.54
agree
1.54
32000
Drainage of chest
1.54
N/A
1.54
agree
1.54
32005
Treat lung lining chemically
2.19
N/A
2.19
agree
2.19
32020
Insertion of chest tube
3.98
N/A
3.98
agree
3.98
32035
Exploration of chest
8.67
N/A
8.67
agree
8.67
32095
Biopsy through chest wall
8.36
N/A
8.36
agree
8.36
32100
Exploration/biopsy of chest
11.84
N/A
15.24
agree
15.24
32110
Explore/repair chest
13.62
N/A
23.00
agree
23.00
32220
Release of lung
19.27
N/A
24.00
agree
24.00
32225
Partial release of lung
13.96
N/A
13.96
agree
13.96
32320
Free/remove chest lining
20.54
N/A
24.00
agree
24.00
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 of lung
18.32
27.17
23.75
agree
23.75
32480
Partial removal of lung
18.32
N/A
23.75
agree
23.75
32482
Bilobectomy
19.71
N/A
25.00
agree
25.00
32491
Lung volume reduction
21.25
N/A
21.25
agree
21.25
32500
Partial removal of lung
14.30
N/A
22.00
agree
22.00
32520
Remove lung & revise chest
21.68
N/A
21.68
agree
21.68
32602
Thoracoscopy, diagnostic
5.96
N/A
5.96
agree
5.96
32651
Thoracoscopy, surgical
12.91
N/A
12.91
agree
12.91
32652
Thoracoscopy, surgical
18.66
N/A
18.66
agree
18.66
32655
Thoracoscopy, surgical
13.10
N/A
13.10
agree
13.10
32657
Thoracoscopy, surgical
13.65
N/A
13.65
agree
13.65
33207
Insertion of heart pacemaker
8.04
WD
(e)
(a)
8.04
33234
Removal of pacemaker system
7.82
N/A
7.82
agree
7.82
33235
Removal of pacemaker electrode
9.40
N/A
9.40
agree
9.40
33400
Repair of aortic valve
25.34
N/A
28.50
agree
28.50
33405
Replacement of aortic valve
30.61
N/A
35.00
agree
35.00
33406
Replacement of aortic valve
32.30
N/A
37.50
agree
37.50
33410
Replacement of aortic valve
32.46
N/A
32.46
agree
32.46
33411
Replacement of aortic valve
32.47
N/A
36.25
agree
36.25
33412
Replacement of aortic valve
34.79
N/A
42.00
agree
42.00
33413
Replacement of aortic valve
35.24
N/A
43.50
agree
43.50
33415
Revision, subvalvular tissue
27.15
N/A
27.15
agree
27.15
33425
Repair of mitral valve
27.00
N/A
27.00
agree
27.00
33426
Repair of mitral valve
31.03
N/A
33.00
agree
33.00
33427
Repair of mitral valve
33.72
N/A
40.00
agree
40.00
33430
Replacement of mitral valve
31.43
N/A
33.50
agree
33.50
33468
Revision of tricuspid valve
30.12
N/A
30.12
agree
30.12
33475
Replacement, pulmonary valve
28.41
N/A
33.00
agree
33.00
33506
Repair artery, translocation
26.71
N/A
35.50
agree
35.50
33510
CABG, vein, single
25.12
N/A
29.00
agree
29.00
33511
CABG, vein, two
27.40
N/A
30.00
agree
30.00
33512
CABG, vein, three
29.67
N/A
31.80
agree
31.80
33513
CABG, vein, four
31.95
N/A
32.00
agree
32.00
33514
CABG, vein, five
35.00
N/A
32.75
agree
32.75
33516
Cabg, vein, six or more
37.40
N/A
35.00
agree
35.00
33517
CABG, artery-vein, single
2.57
N/A
2.57
agree
2.57
33518
CABG, artery-vein, two
4.85
N/A
4.85
agree
4.85
33519
CABG, artery-vein, three
7.12
N/A
7.12
agree
7.12
33521
CABG, artery-vein, four
9.40
N/A
9.40
agree
9.40
33522
CABG, artery-vein, five
11.67
N/A
11.67
agree
11.67
33523
Cabg, art-vein, six or more
13.95
N/A
13.95
agree
13.95
33530
Coronary artery, bypass/reop
5.86
N/A
5.86
agree
5.86
33533
CABG, arterial, single
25.83
N/A
30.00
agree
30.00
33534
CABG, arterial, two
28.82
N/A
32.20
agree
32.20
33535
CABG, arterial, three
31.81
N/A
34.50
agree
34.50
33536
Cabg, arterial, four or more
34.79
N/A
37.50
agree
37.50
33611
Repair double ventricle
32.30
N/A
34.00
agree
34.00
33612
Repair double ventricle
33.26
N/A
35.00
agree
35.00
33615
Repair, simple fontan
32.06
N/A
34.00
agree
34.00
33617
Repair, modified fontan
34.03
N/A
37.00
agree
37.00
33619
Repair single ventricle
37.57
N/A
45.00
agree
45.00
33641
Repair heart septum defect
21.39
N/A
21.39
agree
21.39
33660
Repair of heart defects
25.54
N/A
30.00
agree
30.00
33670
Repair of heart chambers
32.73
N/A
35.00
agree
35.00
33681
Repair heart septum defect
27.67
N/A
30.61
agree
30.61
33694
Repair of heart defects
31.73
N/A
34.00
agree
34.00
33697
Repair of heart defects
33.71
N/A
36.00
agree
36.00
33730
Repair heart-vein defect(s)
31.67
N/A
34.25
agree
34.25
33750
Major vessel shunt
21.41
N/A
21.41
agree
21.41
33767
Major vessel shunt
24.50
N/A
24.50
agree
24.50
33770
Repair great vessels defect
33.29
N/A
37.00
agree
37.00
33778
Repair great vessels defect
35.82
N/A
40.00
agree
40.00
33780
Repair great vessels defect
36.94
N/A
41.75
agree
41.75
33786
Repair arterial trunk
34.84
N/A
39.00
agree
39.00
33820
Revise major vessel
16.29
N/A
16.29
agree
16.29
33840
Remove aorta constriction
20.63
N/A
20.63
agree
20.63
33860
Ascending aortic graft
33.96
N/A
38.00
agree
38.00
33861
Ascending aortic graft
34.52
N/A
42.00
agree
42.00
33863
Ascending aortic graft
36.47
N/A
45.00
agree
45.00
33870
Transverse aortic arch graft
40.31
N/A
44.00
agree
44.00
33875
Thoracic aortic graft
33.06
N/A
CPT
CPT
33.06
33877
Thoracoabdominal graft
42.60
N/A
CPT
CPT
42.60
33917
Repair pulmonary artery
24.50
N/A
24.50
agree
24.50
33919
Repair pulmonary atresia
32.67
N/A
40.00
agree
40.00
33945
Transplantation of heart
42.10
N/A
42.10
agree
42.10
34001
Removal of artery clot
12.91
WD
(e)
(a)
12.91
34101
Removal of artery clot
9.97
N/A
10.00
agree
10.00
34111
Removal of arm artery clot
8.07
N/A
10.00
agree
10.00
34151
Removal of artery clot
16.86
27.51
25.00
agree
25.00
34151
Removal of artery clot
16.86
28.00
25.00
agree
25.00
34201
Removal of artery clot
9.13
10.40
10.03
agree
10.03
34201
Removal of artery clot
9.13
10.58
10.03
agree
10.03
34203
Removal of leg artery clot
12.21
14.99
16.50
agree
16.50
34203
Removal of leg artery clot
12.21
16.50
16.50
agree
16.50
34401
Removal of vein clot
12.86
26.63
25.00
agree
25.00
34401
Removal of vein clot
12.86
28.00
25.00
agree
25.00
34421
Removal of vein clot
9.93
15.75
12.00
agree
12.00
34421
Removal of vein clot
9.93
15.94
12.00
agree
12.00
34451
Removal of vein clot
14.44
29.05
27.00
agree
27.00
34451
Removal of vein clot
14.44
30.00
27.00
agree
27.00
34490
Removal of vein clot
7.60
N/A
9.86
agree
9.86
34501
Repair valve, femoral vein
10.93
N/A
16.00
agree
16.00
34510
Transposition of vein valve
13.25
N/A
18.95
agree
18.95
34520
Cross-over vein graft
13.74
N/A
17.95
agree
17.95
34530
Leg vein fusion
17.61
N/A
16.64
agree
16.64
35011
Repair defect of artery
11.65
14.10
18.00
agree
18.00
35011
Repair defect of artery
11.65
18.00
18.00
agree
18.00
35013
Repair artery rupture, arm
17.40
15.38
22.00
agree
22.00
35013
Repair artery rupture, arm
17.40
20.00
22.00
agree
22.00
35045
Repair defect of arm artery
11.26
11.05
17.57
agree
17.57
35045
Repair defect of arm artery
11.26
16.50
17.57
agree
17.57
35081
Repair defect of artery
28.01
33.13
28.01
agree
28.01
35082
Repair artery rupture, aorta
36.35
37.00
38.50
agree
38.50
35082
Repair artery rupture, aorta
36.35
41.80
38.50
agree
38.50
35092
Repair artery rupture, aorta
38.39
50.00
45.00
agree
45.00
35092
Repair artery rupture, aorta
38.39
58.61
45.00
agree
45.00
35103
Repair artery rupture, groin
33.57
41.00
40.50
agree
40.50
35103
Repair artery rupture, groin
33.57
44.12
40.50
agree
40.50
35111
Repair defect of artery
16.43
23.24
25.00
agree
25.00
35111
Repair defect of artery
16.43
28.00
25.00
agree
25.00
35112
Repair artery rupture,spleen
18.69
29.20
30.00
agree
30.00
35112
Repair artery rupture,spleen
18.69
30.00
30.00
agree
30.00
35121
Repair defect of artery
25.99
30.29
30.00
agree
30.00
35121
Repair defect of artery
25.99
32.00
30.00
agree
30.00
35122
Repair artery rupture, belly
33.45
36.83
35.00
agree
35.00
35122
Repair artery rupture, belly
33.45
37.00
35.00
agree
35.00
35131
Repair defect of artery
18.55
23.15
25.00
agree
25.00
35131
Repair defect of artery
18.55
28.00
25.00
agree
25.00
35132
Repair artery rupture, groin
21.95
30.00
30.00
agree
30.00
35132
Repair artery rupture, groin
21.95
30.54
30.00
agree
30.00
35141
Repair defect of artery
14.46
19.38
20.00
agree
20.00
35141
Repair defect of artery
14.46
20.00
20.00
agree
20.00
35142
Repair artery rupture, thigh
15.86
23.36
23.30
agree
23.30
35142
Repair artery rupture, thigh
15.86
25.00
23.30
agree
23.30
35151
Repair defect of artery
17.00
20.26
22.64
agree
22.64
35151
Repair defect of artery
17.00
22.00
22.64
agree
22.64
35152
Repair artery rupture, knee
16.70
24.98
25.62
agree
25.62
35152
Repair artery rupture, knee
16.70
27.50
25.62
agree
25.62
35182
Repair blood vessel lesion
17.74
N/A
30.00
agree
30.00
35184
Repair blood vessel lesion
12.25
N/A
18.00
agree
18.00
35189
Repair blood vessel lesion
18.43
N/A
28.00
agree
28.00
35190
Repair blood vessel lesion
12.75
N/A
12.75
agree
12.75
35201
Repair blood vessel lesion
9.99
12.74
16.14
agree
16.14
35201
Repair blood vessel lesion
9.99
18.35
16.14
agree
16.14
35206
Repair blood vessel lesion
9.25
N/A
13.25
agree
13.25
35221
Repair blood vessel lesion
16.42
26.00
24.39
agree
24.39
35221
Repair blood vessel lesion
16.42
28.95
24.39
agree
24.39
35226
Repair blood vessel lesion
9.06
14.00
14.50
agree
14.50
35226
Repair blood vessel lesion
9.06
15.82
14.50
agree
14.50
35231
Repair blood vessel lesion
12.00
15.64
20.00
agree
20.00
35231
Repair blood vessel lesion
12.00
18.90
20.00
agree
20.00
35236
Repair blood vessel lesion
10.54
12.85
17.11
agree
17.11
35236
Repair blood vessel lesion
10.54
18.00
17.11
agree
17.11
35246
Repair blood vessel lesion
19.84
26.00
26.45
agree
26.45
35246
Repair blood vessel lesion
19.84
N/A
26.45
agree
26.45
35251
Repair blood vessel lesion
17.49
31.00
30.20
agree
30.20
35251
Repair blood vessel lesion
17.49
34.04
30.20
agree
30.20
35256
Repair blood vessel lesion
11.38
N/A
18.36
agree
18.36
35261
Repair blood vessel lesion
11.63
15.51
17.80
agree
17.80
35261
Repair blood vessel lesion
11.63
18.90
17.80
agree
17.80
35266
Repair blood vessel lesion
10.30
15.79
14.91
agree
14.91
35266
Repair blood vessel lesion
10.30
17.00
14.91
agree
14.91
35276
Repair blood vessel lesion
18.75
22.00
24.25
agree
24.25
35276
Repair blood vessel lesion
18.75
N/A
24.25
agree
24.25
35281
Repair blood vessel lesion
16.48
29.00
28.00
agree
28.00
35281
Repair blood vessel lesion
16.48
32.01
28.00
agree
28.00
35286
Repair blood vessel lesion
11.87
N/A
16.16
agree
16.16
35311
Rechanneling of artery
23.85
30.00
27.00
agree
27.00
35311
Rechanneling of artery
23.85
N/A
27.00
agree
27.00
35321
Rechanneling of artery
11.97
16.47
16.00
agree
16.00
35321
Rechanneling of artery
11.97
18.35
16.00
agree
16.00
35331
Rechanneling of artery
23.52
24.81
26.20
agree
26.20
35331
Rechanneling of artery
23.52
28.01
26.20
agree
26.20
35351
Rechanneling of artery
20.11
24.09
23.00
agree
23.00
35351
Rechanneling of artery
20.11
25.50
23.00
agree
23.00
35355
Rechanneling of artery
16.09
20.01
18.50
agree
18.50
35355
Rechanneling of artery
16.09
20.75
18.50
agree
18.50
35361
Rechanneling of artery
23.59
29.08
28.20
agree
28.20
35361
Rechanneling of artery
23.59
30.00
28.20
agree
28.20
35363
Rechanneling of artery
24.66
32.00
30.20
agree
30.20
35363
Rechanneling of artery
24.66
35.67
30.20
agree
30.20
35371
Rechanneling of artery
11.64
12.97
14.72
agree
14.72
35371
Rechanneling of artery
11.64
17.75
14.72
agree
14.72
35372
Rechanneling of artery
13.56
18.04
18.00
agree
18.00
35372
Rechanneling of artery
13.56
19.53
18.00
agree
18.00
35381
Rechanneling of artery
15.81
N/A
CPT
CPT
15.81
35511
Artery bypass graft
16.83
19.75
21.20
agree
21.20
35511
Artery bypass graft
16.83
21.50
21.20
agree
21.20
35518
Artery bypass graft
15.42
18.59
21.20
agree
21.20
35518
Artery bypass graft
15.42
23.00
21.20
agree
21.20
35521
Artery bypass graft
16.17
20.46
22.20
agree
22.20
35521
Artery bypass graft
16.17
25.25
22.20
agree
22.20
35526
Artery bypass graft
20.00
30.00
29.95
agree
29.95
35526
Artery bypass graft
20.00
N/A
29.95
agree
29.95
35531
Artery bypass graft
25.61
33.62
36.20
agree
36.20
35531
Artery bypass graft
25.61
38.00
36.20
agree
36.20
35533
Artery bypass graft
20.52
28.00
28.00
agree
28.00
35533
Artery bypass graft
20.52
29.99
28.00
agree
28.00
35536
Artery bypass graft
23.11
25.33
31.70
agree
31.70
35536
Artery bypass graft
23.11
33.00
31.70
agree
31.70
35541
Artery bypass graft
25.80
N/A
CPT
CPT
25.80
35546
Artery bypass graft
25.54
N/A
CPT
CPT
25.54
35551
Artery bypass graft
26.67
N/A
CPT
CPT
26.67
35556
Artery bypass graft
21.76
24.50
21.76
agree
21.76
35556
Artery bypass graft
21.76
24.50
21.76
agree
21.76
35558
Artery bypass graft
14.04
22.00
21.20
agree
21.20
35558
Artery bypass graft
14.04
22.08
21.20
agree
21.20
35560
Artery bypass graft
23.56
28.19
32.00
agree
32.00
35560
Artery bypass graft
23.56
35.50
32.00
agree
32.00
35563
Artery bypass graft
15.14
24.00
24.20
agree
24.20
35563
Artery bypass graft
15.14
25.00
24.20
agree
24.20
35565
Artery bypass graft
15.14
23.65
23.20
agree
23.20
35565
Artery bypass graft
15.14
24.00
23.20
agree
23.20
35571
Artery bypass graft
18.58
23.65
24.06
agree
24.06
35571
Artery bypass graft
18.58
26.92
24.06
agree
24.06
35582
Vein bypass graft
27.13
N/A
CPT
CPT
27.13
35587
Vein bypass graft
19.05
24.47
24.75
agree
24.75
35587
Vein bypass graft
19.05
27.00
24.75
agree
24.75
35621
Artery bypass graft
14.54
16.53
20.00
agree
20.00
35621
Artery bypass graft
14.54
21.50
20.00
agree
20.00
35623
Bypass graft, not vein
16.62
17.62
24.00
agree
24.00
35623
Bypass graft, not vein
16.62
25.75
24.00
agree
24.00
35626
Artery bypass graft
23.63
27.58
27.75
agree
27.75
35626
Artery bypass graft
23.63
30.00
27.75
agree
27.75
35631
Artery bypass graft
24.60
32.51
34.00
agree
34.00
35631
Artery bypass graft
24.60
36.00
34.00
agree
34.00
35636
Artery bypass graft
22.46
27.32
29.50
agree
29.50
35636
Artery bypass graft
22.46
36.00
29.50
agree
29.50
35641
Artery bypass graft
24.57
N/A
CPT
CPT
24.57
35646
Artery bypass graft
25.81
N/A
CPT
CPT
25.81
35650
Artery bypass graft
14.36
15.74
19.00
agree
19.00
35650
Artery bypass graft
14.36
19.80
19.00
agree
19.00
35654
Artery bypass graft
18.61
23.54
25.00
agree
25.00
35654
Artery bypass graft
18.61
26.00
25.00
agree
25.00
35661
Artery bypass graft
13.18
17.89
19.00
agree
19.00
35661
Artery bypass graft
13.18
19.53
19.00
agree
19.00
35663
Artery bypass graft
14.17
20.90
22.00
agree
22.00
35663
Artery bypass graft
14.17
23.00
22.00
agree
22.00
35665
Artery bypass graft
15.40
19.84
21.00
agree
21.00
35665
Artery bypass graft
15.40
22.00
21.00
agree
21.00
35666
Artery bypass graft
19.19
20.00
22.19
agree
22.19
35666
Artery bypass graft
19.19
22.00
22.19
agree
22.19
35671
Artery bypass graft
14.80
17.80
19.33
agree
19.33
35671
Artery bypass graft
14.80
24.00
19.33
agree
19.33
35701
Exploration, carotid artery
5.55
9.38
8.50
agree
8.50
35701
Exploration, carotid artery
5.55
15.00
8.50
agree
8.50
35721
Exploration, femoral artery
5.28
N/A
7.18
agree
7.18
35741
Exploration popliteal artery
5.37
N/A
8.00
agree
8.00
35840
Explore abdominal vessels
9.77
N/A
CPT
CPT
9.77
35860
Explore limb vessels
5.55
N/A
CPT
CPT
5.55
35905
Excision, graft, thorax
18.19
32.00
31.25
agree
31.25
35905
Excision, graft, thorax
18.19
N/A
31.25
agree
31.25
35907
Excision, graft, abdomen
19.24
37.33
35.00
agree
35.00
35907
Excision, graft, abdomen
19.24
40.00
35.00
agree
35.00
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 catheter, vein
1.22
2.75
2.50
agree
2.50
36489
Insertion of catheter, vein
1.22
3.41
2.50
agree
2.50
36520
Plasma and/or cell exchange
1.74
N/A
CPT
CPT
1.74
36533
Insertion of access device
5.32
5.28
CPT
CPT
5.32
36534
Revision of access device
2.80
5.15
CPT
CPT
2.80
36535
Removal of access device
2.27
3.89
CPT
CPT
2.27
36600
Withdrawal of arterial blood
0.32
WD
(e)
(a)
0.32
36620
Insertion catheter, artery
1.15
2.25
CPT
CPT
1.15
36625
Insertion catheter, artery
2.11
2.65
2.11
agree
2.11
36822
Insertion of cannula(s)
5.42
19.00
5.42
agree
5.42
37565
Ligation of neck vein
4.44
9.01
10.88
agree
10.88
37565
Ligation of neck vein
4.44
14.50
10.88
agree
10.88
37600
Ligation of neck artery
4.57
9.19
11.25
agree
11.25
37600
Ligation of neck artery
4.57
14.00
11.25
agree
11.25
37605
Ligation of neck artery
6.19
11.85
13.11
agree
13.11
37605
Ligation of neck artery
6.19
17.50
13.11
agree
13.11
37609
Temporal artery procedure
2.30
3.38
3.00
agree
3.00
37609
Temporal artery procedure
2.30
N/A
3.00
agree
3.00
37615
Ligation of neck artery
5.73
12.31
CPT
CPT
5.73
37615
Ligation of neck artery
5.73
18.00
CPT
CPT
5.73
37617
Ligation of abdomen artery
15.95
N/A
22.06
agree
22.06
37618
Ligation of extremity artery
4.84
N/A
CPT
CPT
4.84
37650
Revision of major vein
5.13
N/A
7.80
agree
7.80
37660
Revision of major vein
10.61
N/A
21.00
agree
21.00
37700
Revise leg vein
3.73
N/A
CPT
CPT
3.73
37720
Removal of leg vein
5.66
10.71
CPT
CPT
5.66
37730
Removal of leg veins
7.33
N/A
CPT
CPT
7.33
37735
Removal of leg veins/lesion
10.53
N/A
CPT
CPT
10.53
37760
Revision of leg veins
10.47
N/A
CPT
CPT
10.47
37785
Revision secondary varicosity
3.84
N/A
CPT
CPT
3.84
38100
Removal of spleen, total
13.01
14.70
14.50
agree
14.50
38100
Removal of spleen, total
13.01
16.21
14.50
agree
14.50
38101
Removal of spleen, partial
13.74
14.79
15.31
agree
15.31
38115
Repair of ruptured spleen
14.19
15.55
15.82
agree
15.82
38300
Drainage, lymph node lesion
1.53
1.01
1.99
agree
1.99
38305
Drainage, lymph node lesion
4.61
6.59
6.00
agree
6.00
38308
Incision of lymph channels
4.95
7.35
6.45
agree
6.45
38500
Biopsy/removal, lymph nodes
2.88
3.29
3.75
agree
3.75
38500
Biopsy/removal, lymph nodes
2.88
4.58
3.75
agree
3.75
38510
Biopsy/removal, lymph nodes
4.14
6.28
6.43
agree
6.43
38520
Biopsy/removal, lymph nodes
5.12
6.93
6.67
agree
6.67
38525
Biopsy/removal, lymph nodes
4.66
5.30
6.07
agree
6.07
38530
Biopsy/removal, lymph nodes
6.13
9.58
7.98
agree
7.98
38571
Laparoscopy, lymphadenectomy
12.38
19.84
12.38
agree
12.38
38572
Laparoscopy, lymphadenectomy
14.32
23.17
16.59
agree
16.59
38740
Remove armpit lymph nodes
6.77
10.68
8.42
increase
10.02
38745
Remove armpit lymph nodes
8.84
12.78
11.00
increase
13.00
38746
Remove thoracic lymph nodes
4.39
N/A
4.89
agree
4.89
38760
Remove groin lymph nodes
8.74
11.35
10.88
increase
12.94
38765
Remove groin lymph nodes
16.06
18.77
19.98
agree
19.98
38780
Remove abdomen lymph nodes
16.59
N/A
16.59
agree
16.59
39010
Exploration of chest
11.79
N/A
11.79
agree
11.79
39220
Removal chest lesion
17.42
N/A
17.42
agree
17.42
39400
Visualization of chest
5.61
N/A
5.61
agree
5.61
39503
Repair of diaphragm hernia
34.85
122.75
95.00
decrease
34.85
42205
Reconstruct cleft palate
9.59
12.00
13.29
agree
13.29
43107
Removal of esophagus
28.79
N/A
40.00
agree
40.00
43112
Removal of esophagus
31.22
N/A
43.50
agree
43.50
43117
Partial removal of esophagus
30.02
N/A
40.00
agree
40.00
43122
Parital removal of esophagus
29.11
N/A
40.00
agree
40.00
43215
Esophagus endoscopy
2.60
4.91
CPT
CPT
2.60
43217
Esophagus endoscopy
2.90
3.63
2.90
agree
2.90
43219
Esophagus endoscopy
2.80
3.50
3.18
decrease
2.80
43228
Esoph endoscopy, ablation
3.77
4.72
3.77
agree
3.77
43239
Upper GI endoscopy, biopsy
2.69
2.96
2.87
decrease
2.69
43239
Upper GI endoscopy, biopsy
2.69
3.79
2.87
decrease
2.69
43244
Upper GI endoscopy/ligation
4.59
5.05
5.05
decrease
4.59
43246
Place gastrostomy tube
4.33
4.76
4.33
agree
4.33
43246
Place gastrostomy tube
4.33
5.04
4.33
agree
4.33
43247
Operative upper GI endoscopy
3.39
4.51
3.59
decrease
3.39
43249
Esoph endoscopy, dilation
2.90
5.01
3.35
decrease
2.90
43251
Operative upper GI endoscopy
3.70
4.44
3.70
agree
3.70
43255
Operative upper GI endoscopy
4.40
5.40
4.82
decrease
4.40
43258
Operative upper GI endoscopy
4.55
5.01
4.55
agree
4.55
43259
Endoscopic ultrasound exam
4.89
N/A
8.59
decrease
4.89
43263
Endo cholangiopancreatograph
6.19
7.12
7.29
decrease
6.19
43265
Endo cholangiopancreatograph
8.90
N/A
10.02
decrease
8.90
43269
Endo cholangiopancreatograph
6.04
7.50
8.21
decrease
6.04
43305
Repair esophagus and fistula
17.15
WD
(e)
(a)
17.15
43310
Repair of esophagus
25.39
50.50
CPT
CPT
25.39
43312
Repair esophagus and fistula
28.42
56.75
CPT
CPT
28.42
43320
Fuse esophagus & stomach
16.07
26.45
19.93
agree
19.93
43324
Revise esophagus & stomach
16.58
17.75
20.57
agree
20.57
43325
Revise esophagus & stomach
16.17
21.65
20.06
agree
20.06
43326
Revise esophagus & stomach
15.91
20.53
19.74
agree
19.74
43330
Repair of esophagus
15.94
15.44
19.77
agree
19.77
43331
Repair of esophagus
16.23
17.60
20.13
agree
20.13
43340
Fuse esophagus & intestine
15.81
26.72
19.61
agree
19.61
43341
Fuse esophagus & intestine
16.81
29.07
20.85
agree
20.85
43350
Surgical opening, esophagus
12.72
32.97
15.78
agree
15.78
43351
Surgical opening, esophagus
14.79
31.92
18.35
agree
18.35
43352
Surgical opening, esophagus
12.30
25.47
15.26
agree
15.26
43360
Gastrointestinal repair
28.78
61.17
35.70
agree
35.70
43361
Gastrointestinal repair
32.65
65.83
40.50
agree
40.50
43400
Ligate esophagus veins
17.09
29.96
21.20
agree
21.20
43401
Esophagus surgery for veins
17.81
34.94
22.09
agree
22.09
43405
Ligate/staple esophagus
16.13
36.67
20.01
agree
20.01
43410
Repair esophagus wound
10.86
13.65
13.47
agree
13.47
43415
Repair esophagus wound
17.06
30.45
25.00
agree
25.00
43420
Repair esophagus opening
11.57
14.10
14.35
agree
14.35
43425
Repair esophagus opening
16.95
26.93
21.03
agree
21.03
43500
Surgical opening of stomach
8.44
11.81
11.05
agree
11.05
43501
Surgical repair of stomach
15.31
20.44
20.04
agree
20.04
43502
Surgical repair of stomach
17.67
21.20
23.13
agree
23.13
43510
Surgical opening of stomach
9.99
18.81
13.08
agree
13.08
43520
Incision of pyloric muscle
7.63
8.88
9.99
agree
9.99
43605
Biopsy of stomach
9.15
10.41
11.98
agree
11.98
43610
Excision of stomach lesion
11.15
17.37
14.60
agree
14.60
43611
Excision of stomach lesion
13.63
23.82
17.84
agree
17.84
43620
Removal of stomach
22.54
33.61
30.04
agree
30.04
43621
Removal of stomach
23.06
35.55
30.73
agree
30.73
43622
Removal of stomach
24.41
35.56
32.53
agree
32.53
43631
Removal of stomach, partial
19.66
23.28
22.59
agree
22.59
43632
Removal of stomach, partial
19.66
25.92
22.59
agree
22.59
43633
Removal of stomach, partial
20.10
27.68
23.10
agree
23.10
43634
Removal of stomach, partial
21.86
34.19
25.12
agree
25.12
43638
Removal of stomach, partial
21.76
29.96
29.00
agree
29.00
43638
Removal of stomach, partial
21.76
39.80
29.00
agree
29.00
43639
Removal of stomach, partial
22.25
39.80
29.65
agree
29.65
43640
Vagotomy & pylorus repair
14.81
17.32
17.02
agree
17.02
43641
Vagotomy & pylorus repair
15.03
21.34
17.27
agree
17.27
43651
Laparoscopy, vagus nerve
10.15
15.17
10.15
agree
10.15
43652
Laparoscopy, vagus nerve
12.15
19.21
12.15
agree
12.15
43800
Reconstruction of pylorus
10.46
11.86
13.69
agree
13.69
43810
Fusion of stomach and bowel
11.19
13.81
14.65
agree
14.65
43820
Fusion of stomach and bowel
11.74
15.78
15.37
agree
15.37
43825
Fusion of stomach and bowel
14.68
18.16
19.22
agree
19.22
43830
Place gastrostomy tube
7.28
7.28
9.53
agree
9.53
43832
Place gastrostomy tube
11.92
11.92
15.60
agree
15.60
43840
Repair of stomach lesion
11.89
11.89
15.56
agree
15.56
43842
Gastroplasty for obesity
14.71
17.14
18.47
agree
18.47
43843
Gastroplasty for obesity
14.85
20.62
18.65
agree
18.65
43846
Gastric bypass for obesity
19.15
23.43
24.05
agree
24.05
43847
Gastric bypass for obesity
21.44
29.95
26.92
agree
26.92
43848
Revision gastroplasty
23.41
27.07
29.39
agree
29.39
43850
Revise stomach-bowel fusion
19.69
23.27
24.72
agree
24.72
43855
Revise stomach-bowel fusion
20.83
24.15
26.16
agree
26.16
43860
Revise stomach-bowel fusion
19.91
26.08
25.00
agree
25.00
43865
Revise stomach-bowel fusion
21.12
27.30
26.52
agree
26.52
43870
Repair stomach opening
7.40
9.65
9.69
agree
9.69
43880
Repair stomach-bowel fistula
19.63
23.60
24.65
agree
24.65
44005
Freeing of bowel adhesion
13.84
15.43
16.23
agree
16.23
44010
Incision of small bowel
10.68
15.90
12.52
agree
12.52
44020
Exploration of small bowel
11.93
15.04
13.99
agree
13.99
44021
Decompress small bowel
12.01
15.18
14.08
agree
14.08
44025
Incision of large bowel
12.18
14.08
14.28
agree
14.28
44050
Reduce bowel obstruction
11.40
13.75
14.03
agree
14.03
44050
Reduce bowel obstruction
11.40
14.58
14.03
agree
14.03
44055
Correct malrotation of bowel
13.14
22.00
22.00
agree
22.00
44110
Excision of bowel lesion(s)
10.07
14.39
11.81
agree
11.81
44111
Excision of bowel lesion(s)
12.19
16.32
14.29
agree
14.29
44120
Removal of small intestine
14.50
15.82
17.00
agree
17.00
44125
Removal of small intestine
14.96
17.54
17.54
agree
17.54
44130
Bowel to bowel fusion
12.36
17.87
14.49
agree
14.49
44130
Bowel to bowel fusion
12.36
N/A
14.49
agree
14.49
44140
Partial removal of colon
18.35
20.94
18.35
increase
21.00
44140
Partial removal of colon
18.35
24.58
18.35
increase
21.00
44143
Partial removal of colon
20.17
30.36
20.17
increase
22.99
44144
Partial removal of colon
18.89
29.46
18.89
increase
21.53
44144
Partial removal of colon
18.89
N/A
18.89
increase
21.53
44145
Partial removal of colon
23.18
27.91
23.18
increase
26.42
44146
Partial removal of colon
24.16
30.97
24.16
increase
27.54
44147
Partial removal of colon
18.17
N/A
18.17
increase
20.71
44150
Removal of colon
21.01
27.41
21.01
increase
23.95
44151
Removal of colon/ileostomy
20.04
32.89
20.04
increase
26.88
44151
Removal of colon/ileostomy
20.04
N/A
20.04
increase
26.88
44152
Removal of colon/ileostomy
24.41
33.61
24.41
increase
27.83
44153
Removal of colon/ileostomy
26.83
33.11
26.83
increase
30.59
44155
Removal of colon/ileostomy
24.44
33.61
24.44
increase
27.86
44156
Removal of colon/ileostomy
23.01
36.27
23.01
increase
30.79
44156
Removal of colon/ileostomy
23.01
N/A
23.01
increase
30.79
44160
Removal of colon
15.88
17.45
18.62
agree
18.62
44200
Laparoscopy, enterolysis
14.44
16.11
14.44
agree
14.44
44300
Open bowel to skin
8.88
13.09
12.11
agree
12.11
44310
Ileostomy/jejunostomy
11.70
18.14
15.95
agree
15.95
44312
Revision of ileostomy
5.88
6.79
8.02
agree
8.02
44314
Revision of ileostomy
11.04
14.45
15.05
agree
15.05
44316
Devise bowel pouch
15.47
26.57
21.09
agree
21.09
44320
Colostomy
12.94
18.84
17.64
agree
17.64
44340
Revision of colostomy
5.66
6.79
7.72
agree
7.72
44345
Revision of colostomy
11.32
14.45
15.43
agree
15.43
44346
Revision of colostomy
12.46
17.19
16.99
agree
16.99
44388
Colon endoscopy
2.82
3.10
3.70
decrease
2.82
44389
Colonoscopy with biopsy
3.13
3.44
4.26
decrease
3.13
44390
Colonoscopy for foreign body
3.83
4.21
4.81
decrease
3.83
44391
Colonoscopy for bleeding
4.32
4.75
5.18
decrease
4.32
44392
Colonoscopy and polypectomy
3.82
4.20
4.81
decrease
3.82
44393
Colonoscopy, lesion removal
4.84
5.32
5.00
decrease
4.84
44394
Colonoscopy w/snare
4.43
4.87
4.43
agree
4.43
44394
Colonoscopy w/snare
4.43
N/A
4.43
agree
4.43
44602
Suture, small intestine
10.61
15.26
11.91
increase
16.03
44603
Suture, small intestine
14.00
19.50
15.72
increase
18.66
44604
Suture, large intestine
14.28
16.59
16.03
agree
16.03
44605
Repair of bowel lesion
15.37
25.03
17.25
increase
19.53
44615
Intestinal stricturoplasty
14.19
18.97
15.93
agree
15.93
44620
Repair bowel opening
10.87
14.99
12.20
agree
12.20
44625
Repair bowel opening
13.41
16.79
15.05
agree
15.05
44626
Repair bowel opening
22.59
24.43
25.36
agree
25.36
44640
Repair bowel-skin fistula
14.83
22.29
16.65
increase
21.65
44650
Repair bowel fistula
15.25
22.29
17.12
increase
22.27
44660
Repair bowel-bladder fistula
14.63
24.70
16.42
increase
21.36
44661
Repair bowel-bladder fistula
16.99
25.63
19.07
increase
24.81
44680
Surgical revision, intestine
13.72
21.32
15.40
agree
15.40
44700
Suspend bowel w/prosthesis
14.35
19.35
16.11
agree
16.11
44800
Excision of bowel pouch
11.23
10.85
11.23
agree
11.23
44820
Excision of mesentery lesion
10.31
11.23
12.09
agree
12.09
44850
Repair of mesentery
9.57
12.00
10.74
agree
10.74
44900
Drain app abscess, open
8.82
11.79
10.14
agree
10.14
44950
Appendectomy
8.70
8.37
10.00
agree
10.00
44960
Appendectomy
10.74
13.67
12.34
agree
12.34
44970
Laparoscopy, appendectomy
8.70
10.26
8.70
agree
8.70
45000
Drainage of pelvic abscess
4.52
10.29
3.88
increase
4.52
45020
Drainage of rectal abscess
4.72
7.71
4.05
increase
4.72
45100
Biopsy of rectum
3.68
4.34
3.16
increase
3.68
45108
Removal of anorectal lesion
4.76
5.25
4.09
increase
4.76
45110
Removal of rectum
23.80
29.53
28.00
agree
28.00
45111
Partial removal of rectum
16.48
N/A
16.48
agree
16.48
45112
Removal of rectum
25.96
32.46
30.54
agree
30.54
45113
Partial proctectomy
25.99
33.11
30.58
agree
30.58
45114
Partial removal of rectum
23.22
29.46
27.32
agree
27.32
45116
Partial removal of rectum
20.89
21.98
24.58
agree
24.58
45119
Remove rectum w/reservoir
26.21
31.60
30.84
agree
30.84
45120
Removal of rectum
24.60
31.09
24.60
agree
24.60
45121
Removal of rectum and colon
27.04
32.14
27.04
agree
27.04
45123
Partial proctectomy
14.20
22.51
16.71
agree
16.71
45126
Pelvic exenteration
38.39
47.99
45.16
agree
45.16
45130
Excision of rectal prolapse
13.97
14.26
16.44
agree
16.44
45135
Excision of rectal prolapse
16.39
30.14
19.28
agree
19.28
45160
Excision of rectal lesion
13.02
19.86
15.32
agree
15.32
45170
Excision of rectal lesion
9.77
12.81
11.49
agree
11.49
45190
Destruction, rectal tumor
8.28
9.09
9.74
agree
9.74
45305
Proctosigmoidoscopy & biopsy
1.01
1.22
1.01
agree
1.01
45309
Proctosigmoidoscopy
2.01
2.45
2.01
agree
2.01
45330
Diagnostic sigmoidoscopy
0.96
1.39
0.96
agree
0.96
45337
Sigmoidoscopy & decompress
2.36
N/A
2.36
agree
2.36
45339
Sigmoidoscopy
3.14
N/A
3.14
agree
3.14
45378
Diagnostic colonoscopy
3.70
4.66
3.70
agree
3.70
45380
Colonoscopy and biopsy
4.01
5.01
4.44
decrease
4.01
45383
Lesion removal colonoscopy
5.87
7.34
5.87
agree
5.87
45384
Colonoscopy
4.70
5.88
4.70
agree
4.70
45385
Lesion removal colonoscopy
5.31
6.64
5.31
agree
5.31
45505
Repair of rectum
6.02
7.57
7.58
agree
7.58
45540
Correct rectal prolapse
12.92
17.79
16.27
agree
16.27
45541
Correct rectal prolapse
10.64
13.23
13.40
agree
13.40
45550
Repair rectum/remove sigmoid
18.26
27.91
23.00
agree
23.00
45560
Repair of rectocele
8.40
7.70
10.58
agree
10.58
45562
Exploration/repair of rectum
12.21
12.09
15.38
agree
15.38
45563
Exploration/repair of rectum
18.63
21.50
23.47
agree
23.47
45800
Repair rect/bladder fistula
14.11
14.36
17.77
agree
17.77
45805
Repair fistula w/colostomy
16.50
20.94
20.78
agree
20.78
45820
Repair rectourethral fistula
14.67
13.81
18.48
agree
18.48
45825
Repair fistula w/colostomy
16.87
20.38
21.25
agree
21.25
45900
Reduction of rectal prolapse
1.83
3.27
2.61
agree
2.61
45905
Dilation of anal sphincter
1.61
3.15
2.30
agree
2.30
45910
Dilation of rectal narrowing
1.96
3.23
2.80
agree
2.80
45910
Dilation of rectal narrowing
1.96
N/A
2.80
agree
2.80
45915
Remove rectal obstruction
2.20
3.58
3.14
agree
3.14
46040
Incision of rectal abscess
4.96
5.53
4.26
increase
4.96
46045
Incision of rectal abscess
4.32
5.38
3.71
increase
4.32
46060
Incision of rectal abscess
5.69
8.55
4.89
increase
5.69
46083
Incise external hemorrhoid
1.40
1.52
1.40
agree
1.40
46083
Incise external hemorrhoid
1.40
2.34
1.40
agree
1.40
46221
Ligation of hemorrhoid(s)
1.43
1.94
2.04
agree
2.04
46230
Removal of anal tabs
2.57
1.94
2.57
agree
2.57
46250
Hemorrhoidectomy
4.53
4.13
3.89
agree
3.89
46255
Hemorrhoidectomy
5.36
4.98
4.60
agree
4.60
46257
Remove hemorrhoids & fissure
6.28
5.43
5.40
agree
5.40
46258
Remove hemorrhoids & fistula
6.67
5.86
5.73
agree
5.73
46258
Remove hemorrhoids & fistula
6.67
N/A
5.73
agree
5.73
46260
Hemorrhoidectomy
7.42
6.18
6.37
agree
6.37
46261
Remove hemorrhoids & fissure
8.24
7.11
7.08
agree
7.08
46262
Remove hemorrhoids & fistula
8.73
7.11
7.50
agree
7.50
46270
Removal of anal fistula
3.72
4.28
3.20
increase
3.72
46275
Removal of anal fistula
4.56
5.18
3.92
increase
4.56
46280
Removal of anal fistula
5.98
5.95
5.14
increase
5.98
46288
Repair anal fistula
7.13
8.08
6.13
increase
7.13
46320
Removal of hemorrhoid clot
1.61
1.52
1.61
agree
1.61
46320
Removal of hemorrhoid clot
1.61
2.63
1.61
agree
1.61
46700
Repair of anal stricture
7.25
10.22
9.13
agree
9.13
46705
Repair of anal stricture
7.17
6.90
6.90
agree
6.90
46715
Repair of anovaginal fistula
7.46
7.20
7.20
agree
7.20
46716
Repair of anovaginal fistula
12.15
15.15
15.07
agree
15.07
46730
Construction of absent anus
21.57
25.50
26.75
agree
26.75
46735
Construction of absent anus
25.94
36.00
32.17
agree
32.17
46740
Construction of absent anus
23.11
35.00
30.00
agree
30.00
46742
Repair of imperforated anus
29.67
38.00
35.80
agree
35.80
46744
Repair of cloacal anomaly
33.21
52.00
52.63
agree
52.63
46746
Repair of cloacal anomaly
36.74
53.50
58.22
agree
58.22
46748
Repair of cloacal anomaly
40.52
55.00
64.21
agree
64.21
46750
Repair of anal sphincter
8.14
10.99
10.25
agree
10.25
46753
Reconstruction of anus
6.58
5.45
8.29
agree
8.29
46754
Removal of suture from anus
1.54
2.93
2.20
agree
2.20
46760
Repair of anal sphincter
11.46
21.77
14.43
agree
14.43
46761
Repair of anal sphincter
10.99
12.15
13.84
agree
13.84
46762
Implant artificial sphincter
10.09
15.01
12.71
agree
12.71
46900
Destruction, anal lesion(s)
1.91
1.32
1.91
agree
1.91
46910
Destruction, anal lesion(s)
1.86
1.72
1.86
agree
1.86
46916
Cryosurgery, anal lesion(s)
1.86
1.72
1.86
agree
1.86
46917
Laser surgery, anal lesions
1.86
3.32
1.86
agree
1.86
46922
Excision of anal lesion(s)
1.86
3.12
1.86
agree
1.86
46924
Destruction, anal lesion(s)
2.76
3.93
2.76
agree
2.76
46924
Destruction, anal lesion(s)
2.76
4.24
2.76
agree
2.76
46934
Destruction of hemorrhoids
4.08
4.63
3.51
agree
3.51
46935
Destruction of hemorrhoids
2.43
4.17
2.43
agree
2.43
46936
Destruction of hemorrhoids
4.30
5.12
3.69
agree
3.69
46940
Treatment of anal fissure
2.32
1.71
2.32
agree
2.32
46942
Treatment of anal fissure
2.04
1.71
2.04
agree
2.04
46945
Ligation of hemorrhoids
2.14
2.37
1.84
agree
1.84
46946
Ligation of hemorrhoids
3.00
2.57
2.58
agree
2.58
47010
Open drainage, liver lesion
10.28
16.25
16.01
agree
16.01
47015
Inject/aspirate liver cyst
9.70
19.15
15.11
agree
15.11
47100
Wedge biopsy of liver
7.49
9.24
11.67
agree
11.67
47120
Partial removal of liver
22.79
39.57
35.50
agree
35.50
47122
Extensive removal of liver
35.39
53.02
55.13
agree
55.13
47125
Partial removal of liver
31.58
44.50
49.19
agree
49.19
47130
Partial removal of liver
34.25
46.45
53.35
agree
53.35
47134
Partial removal, donor liver
39.15
49.00
CPT
CPT
39.15
47300
Surgery for liver lesion
9.68
12.45
15.08
agree
15.08
47350
Repair liver wound
12.56
19.16
19.56
agree
19.56
47360
Repair liver wound
17.28
28.64
26.92
agree
26.92
47361
Repair liver wound
30.25
40.14
47.12
agree
47.12
47362
Repair liver wound
11.88
24.94
18.51
agree
18.51
47400
Incision of liver duct
20.86
35.12
32.49
agree
32.49
47420
Incision of bile duct
16.72
27.63
19.88
agree
19.88
47425
Incision of bile duct
16.68
32.49
19.83
agree
19.83
47460
Incise bile duct sphincter
15.17
25.74
18.04
agree
18.04
47480
Incision of gallbladder
9.10
15.26
10.82
agree
10.82
47562
Laparoscopic cholecystectomy
11.09
9.59
11.09
agree
11.09
47563
Laparoscopic cholecystectomy
11.94
12.40
11.94
agree
11.94
47564
Laparo cholecystectomy/explr
14.23
17.67
14.23
agree
14.23
47570
Laparo cholecystoenterostomy
12.58
18.62
12.58
agree
12.58
47600
Removal of gallbladder
11.42
11.67
13.58
agree
13.58
47605
Removal of gallbladder
12.36
13.26
14.69
agree
14.69
47610
Removal of gallbladder
15.83
17.97
18.82
agree
18.82
47612
Removal of gallbladder
15.80
22.68
18.78
agree
18.78
47620
Removal of gallbladder
17.36
24.70
20.64
agree
20.64
47701
Bile duct revision
27.81
36.50
27.81
agree
27.81
47711
Excision of bile duct tumor
19.37
31.38
23.03
agree
23.03
47712
Excision of bile duct tumor
25.44
38.58
30.24
agree
30.24
47715
Excision of bile duct cyst
15.81
32.81
18.80
agree
18.80
47716
Fusion of bile duct cyst
13.83
19.34
16.44
agree
16.44
47720
Fuse gallbladder & bowel
13.38
18.16
15.91
agree
15.91
47721
Fuse upper gi structures
16.08
21.91
19.12
agree
19.12
47740
Fuse gallbladder & bowel
15.54
20.63
18.48
agree
18.48
47741
Fuse gallbladder & bowel
17.95
24.39
21.34
agree
21.34
47760
Fuse bile ducts and bowel
21.74
21.91
25.85
agree
25.85
47765
Fuse liver ducts & bowel
20.93
30.62
24.88
agree
24.88
47780
Fuse bile ducts and bowel
22.29
26.86
26.50
agree
26.50
47785
Fuse bile ducts and bowel
26.23
36.32
31.18
agree
31.18
47800
Reconstruction of bile ducts
19.60
26.89
23.30
agree
23.30
47801
Placement, bile duct support
12.76
23.47
15.17
agree
15.17
47802
Fuse liver duct & intestine
18.13
34.11
21.55
agree
21.55
47900
Suture bile duct injury
16.74
20.50
19.90
agree
19.90
48000
Drainage of abdomen
14.91
40.79
28.07
agree
28.07
48001
Placement of drain, pancreas
18.83
55.20
35.45
agree
35.45
48005
Resect/debride pancreas
22.40
57.70
42.17
agree
42.17
48020
Removal of pancreatic stone
14.22
23.50
15.70
agree
15.70
48100
Biopsy of pancreas
11.08
14.57
12.23
agree
12.23
48120
Removal of pancreas lesion
14.36
26.05
15.85
agree
15.85
48140
Partial removal of pancreas
20.78
28.60
22.94
agree
22.94
48145
Partial removal of pancreas
21.76
34.32
24.02
agree
24.02
48146
Pancreatectomy
23.91
45.57
26.40
agree
26.40
48148
Removal of pancreatic duct
15.71
25.00
17.34
agree
17.34
48150
Partial removal of pancreas
43.48
54.73
48.00
agree
48.00
48150
Partial removal of pancreas
43.48
54.75
48.00
agree
48.00
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 pancreas
22.32
44.70
24.64
agree
24.64
48180
Fuse pancreas and bowel
22.39
32.52
24.72
agree
24.72
48500
Surgery of pancreas cyst
13.84
18.99
15.28
agree
15.28
48510
Drain pancreatic pseudocyst
12.96
16.08
14.31
agree
14.31
48520
Fuse pancreas cyst and bowel
14.12
19.68
15.59
agree
15.59
48540
Fuse pancreas cyst and bowel
17.86
21.28
19.72
agree
19.72
48545
Pancreatorrhaphy
16.47
33.39
18.18
agree
18.18
48547
Duodenal exclusion
23.40
41.76
25.83
agree
25.83
49000
Exploration of abdomen
11.68
13.42
11.68
agree
11.68
49002
Reopening of abdomen
10.49
12.67
10.49
agree
10.49
49010
Exploration behind abdomen
12.28
15.06
12.28
agree
12.28
49020
Drain abdominal abscess
16.79
28.33
20.73
increase
22.84
49040
Drain, open, abdom abscess
9.94
23.60
12.27
increase
13.52
49060
Drain, open, retrop abscess
11.66
19.52
14.40
increase
15.86
49085
Remove abdomen foreign body
8.93
14.23
11.03
increase
12.14
49200
Removal of abdominal lesion
10.25
12.19
10.25
agree
10.25
49201
Removal of abdominal lesion
14.84
16.27
14.84
agree
14.84
49215
Excise sacral spine tumor
22.36
24.96
33.50
agree
33.50
49215
Excise sacral spine tumor
22.36
30.00
33.50
agree
33.50
49220
Multiple surgery, abdomen
14.88
17.39
14.88
agree
14.88
49255
Removal of omentum
11.14
13.42
11.14
agree
11.14
49320
Diag laparo separate proc
5.10
5.95
5.10
agree
5.10
49321
Laparoscopy; biopsy
5.40
N/A
5.40
agree
5.40
49322
Laparoscopy; aspiration
5.70
N/A
5.70
agree
5.70
49421
Insert abdominal drain
5.54
6.99
5.54
agree
5.54
49422
Remove perm cannula/catheter
6.25
6.35
6.25
agree
6.25
49425
Insert abdomen-venous drain
11.37
13.82
11.37
agree
11.37
49426
Revise abdomen-venous shunt
9.63
11.10
9.63
agree
9.63
49428
Ligation of shunt
2.38
5.38
6.06
agree
6.06
49429
Removal of shunt
7.40
9.57
7.40
agree
7.40
49495
Repair inguinal hernia, init
5.89
6.96
CPT
CPT
5.89
49495
Repair inguinal hernia, init
5.89
12.50
CPT
CPT
5.89
49496
Repair inguinal hernia, init
8.79
10.56
CPT
CPT
8.79
49496
Repair inguinal hernia, init
8.79
14.00
CPT
CPT
8.79
49500
Repair inguinal hernia
4.68
7.61
5.48
agree
5.48
49501
Repair inguinal hernia, init
7.58
9.26
8.88
agree
8.88
49505
Repair inguinal hernia
6.49
8.31
7.60
agree
7.60
49505
Repair inguinal hernia
6.49
11.50
7.60
agree
7.60
49507
Repair inguinal hernia
8.17
11.38
9.57
agree
9.57
49520
Rerepair inguinal hernia
8.22
11.02
9.63
agree
9.63
49521
Repair inguinal hernia, rec
10.22
13.97
11.97
agree
11.97
49525
Repair inguinal hernia
7.32
8.36
8.57
agree
8.57
49540
Repair lumbar hernia
8.87
8.52
10.39
agree
10.39
49550
Repair femoral hernia
7.37
8.36
8.63
agree
8.63
49553
Repair femoral hernia, init
8.06
10.31
9.44
agree
9.44
49555
Repair femoral hernia
7.71
8.50
9.03
agree
9.03
49557
Repair femoral hernia, recur
9.52
11.82
11.15
agree
11.15
49560
Repair abdominal hernia
9.88
11.69
11.57
agree
11.57
49561
Repair incisional hernia
12.17
15.67
14.25
agree
14.25
49565
Rerepair abdominal hernia
9.88
14.03
11.57
agree
11.57
49566
Repair incisional hernia
12.30
16.43
14.40
agree
14.40
49570
Repair epigastric hernia
4.86
7.00
5.69
agree
5.69
49572
Repair epigastric hernia
5.75
9.77
6.73
agree
6.73
49580
Repair umbilical hernia
3.51
5.71
4.11
agree
4.11
49582
Repair umbilical hernia
5.68
9.99
6.65
agree
6.65
49585
Repair umbilical hernia
5.32
5.71
6.23
agree
6.23
49587
Repair umbilical hernia
6.46
9.34
7.56
agree
7.56
49590
Repair abdominal hernia
7.29
9.54
8.54
agree
8.54
49605
Repair umbilical lesion
22.66
97.62
76.00
decrease
22.66
49606
Repair umbilical lesion
18.60
21.31
18.60
agree
18.60
49650
Laparo hernia repair initial
6.27
7.66
6.27
agree
6.27
49651
Laparo hernia repair recur
8.24
7.88
8.24
agree
8.24
49900
Repair of abdominal wall
12.28
16.92
12.28
agree
12.28
49905
Omental flap
6.55
17.79
CPT
CPT
6.55
50200
Biopsy of kidney
2.63
N/A
CPT
CPT
2.63
50230
Removal of kidney
22.07
N/A
CPT
CPT
22.07
51595
Remove bladder/revise tract
37.14
N/A
37.14
agree
37.14
51596
Remove bladder/create pouch
39.52
N/A
39.52
agree
39.52
52300
Cystoscopy and treatment
5.31
WD
(e)
(a)
5.31
52327
Cystoscopy, inject material
5.19
WD
(e)
(a)
5.19
52340
Cystoscopy and treatment
9.68
WD
(e)
(a)
9.68
56515
Destruction, vulva lesion(s)
1.88
3.09
2.76
agree
2.76
56740
Remove vagina gland lesion
3.76
5.74
4.57
agree
4.57
57100
Biopsy of vagina
0.97
1.90
1.20
agree
1.20
57130
Remove vagina lesion
2.43
5.67
2.43
agree
2.43
57292
Construct vagina with graft
13.09
N/A
13.09
agree
13.09
57307
Fistula repair & colostomy
15.93
20.24
15.93
agree
15.93
57410
Pelvic examination
1.75
4.08
1.75
agree
1.75
57505
Endocervical curettage
1.14
0.97
1.14
agree
1.14
57555
Remove cervix/repair vagina
8.95
WD
(e)
(a)
8.95
58150
Total hysterectomy
15.24
17.75
15.24
agree
15.24
58152
Total hysterectomy
15.09
20.60
20.60
agree
20.60
58260
Vaginal hysterectomy
12.20
12.98
12.98
agree
12.98
58262
Vaginal hysterectomy
13.99
17.88
14.77
agree
14.77
58263
Vaginal hysterectomy
15.28
21.26
16.06
agree
16.06
58267
Hysterectomy & vagina repair
15.00
17.55
17.04
agree
17.04
58270
Hysterectomy & vagina repair
13.48
15.58
14.26
agree
14.26
58275
Hysterectomy/revise vagina
14.98
N/A
15.76
agree
15.76
58280
Hysterectomy/revise vagina
15.41
N/A
17.01
agree
17.01
58285
Extensive hysterectomy
18.57
N/A
22.26
agree
22.26
58323
Sperm washing
0.23
0.55
0.23
agree
0.23
58400
Suspension of uterus
6.36
11.68
6.36
agree
6.36
58600
Division of fallopian tube
3.84
4.60
5.60
agree
5.60
58605
Division of fallopian tube
3.34
4.60
5.00
agree
5.00
58611
Ligate oviduct(s) add-on
0.63
N/A
1.45
agree
1.45
58700
Removal of fallopian tube
6.49
11.68
12.05
agree
12.05
58740
Revise fallopian tube(s)
5.83
11.29
14.00
agree
14.00
58805
Drainage of ovarian cyst(s)
5.88
11.68
5.88
agree
5.88
58820
Drain ovary abscess, open
4.22
6.03
4.22
agree
4.22
58825
Transposition, ovary(s)
6.13
11.68
10.98
agree
10.98
58920
Partial removal of ovary(s)
6.78
11.68
11.36
agree
11.36
58950
Resect ovarian malignancy
15.27
16.93
16.93
agree
16.93
58951
Resect ovarian malignancy
21.81
28.99
22.38
agree
22.38
59150
Treat ectopic pregnancy
6.89
11.67
11.67
agree
11.67
59151
Treat ectopic pregnancy
7.86
11.49
11.49
agree
11.49
59812
Treatment of miscarriage
3.25
4.01
4.01
agree
4.01
59870
Evacuate mole of uterus
4.28
5.00
6.01
agree
6.01
60100
Biopsy of thyroid
0.97
1.88
1.56
agree
1.56
60220
Partial removal of thyroid
10.53
11.82
11.90
agree
11.90
60220
Partial removal of thyroid
10.53
14.24
11.90
agree
11.90
60252
Removal of thyroid
18.20
22.32
20.57
agree
20.57
60254
Extensive thyroid surgery
23.88
27.43
26.99
agree
26.99
60260
Repeat thyroid surgery
15.46
18.83
17.47
agree
17.47
60270
Removal of thyroid
17.94
23.05
20.27
agree
20.27
60271
Removal of thyroid
14.89
18.68
16.83
agree
16.83
60280
Remove thyroid duct lesion
6.08
WD
(e)
(a)
6.08
60540
Explore adrenal gland
17.03
20.53
17.03
agree
17.03
60545
Explore adrenal gland
19.88
25.66
19.88
agree
19.88
62263
Lysis epidural adhesions
6.14
7.20
7.20
(b)
6.14
62310
Inject spine c/t
1.91
1.95
2.20
(b)
1.91
62311
Inject spine l/s (cd)
1.54
1.57
1.78
(b)
1.54
62318
Inject spine w/cath, c/t
2.04
2.26
2.35
(b)
2.04
62319
Inject spine w/cath l/s (cd)
1.87
1.88
2.15
(b)
1.87
65855
Laser surgery of eye
4.30
N/A
3.85
agree
3.85
66170
Glaucoma surgery
12.16
WD
(e)
(a)
12.16
66172
Incision of eye
15.04
WD
(e)
(a)
15.04
66180
Implant eye shunt
14.55
N/A
14.55
agree
14.55
66986
Exchange lens prosthesis
12.28
N/A
12.28
agree
12.28
67028
Injection eye drug
2.52
N/A
2.52
agree
2.52
67108
Repair detached retina
20.82
WD
(e)
(a)
20.82
67218
Treatment of retinal lesion
13.52
N/A
18.53
agree
18.53
67904
Repair eyelid defect
6.26
N/A
6.26
agree
6.26
69000
Drain external ear lesion
1.45
WD
(e)
(a)
1.45
69005
Drain external ear lesion
2.11
WD
(e)
(a)
2.11
69020
Drain outer ear canal lesion
1.48
WD
(e)
(a)
1.48
69100
Biopsy of external ear
0.81
WD
(e)
(a)
0.81
69105
Biopsy of external ear canal
0.85
WD
(e)
(a)
0.85
69110
Remove external ear, partial
3.44
WD
(e)
(a)
3.44
69120
Removal of external ear
4.05
WD
(e)
(a)
4.05
69140
Remove ear canal lesion(s)
7.97
WD
(e)
(a)
7.97
69145
Remove ear canal lesion(s)
2.62
WD
(e)
(a)
2.62
69150
Extensive ear canal surgery
13.43
WD
(e)
(a)
13.43
69155
Extensive ear/neck surgery
20.80
WD
(e)
(a)
20.80
69200
Clear outer ear canal
0.77
WD
(e)
(a)
0.77
69205
Clear outer ear canal
1.20
WD
(e)
(a)
1.20
69210
Remove impacted ear wax
0.61
WD
(e)
(a)
0.61
69220
Clean out mastoid cavity
0.83
WD
(e)
(a)
0.83
69222
Clean out mastoid cavity
1.40
WD
(e)
(a)
1.40
69300
Revise external ear
6.36
WD
(e)
(a)
6.36
69310
Rebuild outer ear canal
10.79
WD
(e)
(a)
10.79
69320
Rebuild outer ear canal
16.96
WD
(e)
(a)
16.96
69400
Inflate middle ear canal
0.83
WD
(e)
(a)
0.83
69401
Inflate middle ear canal
0.63
WD
(e)
(a)
0.63
69405
Catheterize middle ear canal
2.63
WD
(e)
(a)
2.63
69410
Inset middle ear (baffle)
0.33
WD
(e)
(a)
0.33
69420
Incision of eardrum
1.33
WD
(e)
(a)
1.33
69421
Incision of eardrum
1.73
WD
(e)
(a)
1.73
69424
Remove ventilating tube
0.85
WD
(e)
(a)
0.85
69433
Create eardrum opening
1.52
WD
(e)
(a)
1.52
69436
Create eardrum opening
1.96
WD
(e)
(a)
1.96
69440
Exploration of middle ear
7.57
WD
(e)
(a)
7.57
69450
Eardrum revision
5.57
WD
(e)
(a)
5.57
69501
Mastoidectomy
9.07
WD
(e)
(a)
9.07
69502
Mastoidectomy
12.38
WD
(e)
(a)
12.38
69505
Remove mastoid structures
12.99
WD
(e)
(a)
12.99
69511
Extensive mastoid surgery
13.52
WD
(e)
(a)
13.52
69530
Extensive mastoid surgery
19.19
WD
(e)
(a)
19.19
69535
Remove part of temporal bone
36.14
WD
(e)
(a)
36.14
69540
Remove ear lesion
1.20
WD
(e)
(a)
1.20
69550
Remove ear lesion
10.99
WD
(e)
(a)
10.99
69552
Remove ear lesion
19.46
WD
(e)
(a)
19.46
69554
Remove ear lesion
33.16
WD
(e)
(a)
33.16
69601
Mastoid surgery revision
13.24
WD
(e)
(a)
13.24
69602
Mastoid surgery revision
13.58
WD
(e)
(a)
13.58
69603
Mastoid surgery revision
14.02
WD
(e)
(a)
14.02
69604
Mastoid surgery revision
14.02
WD
(e)
(a)
14.02
69605
Remove mastoid structures
18.49
WD
(e)
(a)
18.49
69610
Repair of eardrum
4.43
WD
(e)
(a)
4.43
69620
Repair of eardrum
5.89
WD
(e)
(a)
5.89
69631
Rebuild eardrum structures
9.86
WD
(e)
(a)
9.86
69632
Rebuild eardrum structures
12.75
WD
(e)
(a)
12.75
69633
Rebuild eardrum structures
12.10
WD
(e)
(a)
12.10
69635
Repair eardrum structures
13.33
WD
(e)
(a)
13.33
69636
Rebuild eardrum structures
15.22
WD
(e)
(a)
15.22
69637
Rebuild eardrum structures
15.11
WD
(e)
(a)
15.11
69641
Revise middle ear & mastoid
12.71
WD
(e)
(a)
12.71
69642
Revise middle ear & mastoid
16.84
WD
(e)
(a)
16.84
69643
Revise middle ear & mastoid
15.32
WD
(e)
(a)
15.32
69644
Revise middle ear & mastoid
16.97
WD
(e)
(a)
16.97
69645
Revise middle ear & mastoid
16.38
WD
(e)
(a)
16.38
69646
Revise middle ear & mastoid
17.99
WD
(e)
(a)
17.99
69650
Release middle ear bone
9.66
WD
(e)
(a)
9.66
69660
Revise middle ear bone
11.90
WD
(e)
(a)
11.90
69661
Revise middle ear bone
15.74
WD
(e)
(a)
15.74
69662
Revise middle ear bone
15.44
WD
(e)
(a)
15.44
69666
Repair middle ear structures
9.75
WD
(e)
(a)
9.75
69667
Repair middle ear structures
9.76
WD
(e)
(a)
9.76
69670
Remove mastoid air cells
11.51
WD
(e)
(a)
11.51
69676
Remove middle ear nerve
9.52
WD
(e)
(a)
9.52
69700
Close mastoid fistula
8.23
WD
(e)
(a)
8.23
69711
Remove/repair hearing aid
10.44
WD
(e)
(a)
10.44
69720
Release facial nerve
14.38
WD
(e)
(a)
14.38
69725
Release facial nerve
25.38
WD
(e)
(a)
25.38
69740
Repair facial nerve
15.96
WD
(e)
(a)
15.96
69745
Repair facial nerve
16.69
WD
(e)
(a)
16.69
69801
Incise inner ear
8.56
WD
(e)
(a)
8.56
69802
Incise inner ear
13.10
WD
(e)
(a)
13.10
69805
Explore inner ear
13.82
WD
(e)
(a)
13.82
69806
Explore inner ear
12.35
WD
(e)
(a)
12.35
69820
Establish inner ear window
10.34
WD
(e)
(a)
10.34
69840
Revise inner ear window
10.26
WD
(e)
(a)
10.26
69905
Remove inner ear
11.10
WD
(e)
(a)
11.10
69910
Remove inner ear & mastoid
13.63
WD
(e)
(a)
13.63
69915
Incise inner ear nerve
21.23
WD
(e)
(a)
21.23
69930
Implant cochlear device
16.81
WD
(e)
(a)
16.81
69950
Incise inner ear nerve
25.64
WD
(e)
(a)
25.64
69955
Release facial nerve
27.04
WD
(e)
(a)
27.04
69960
Release inner ear canal
27.04
WD
(e)
(a)
27.04
69970
Remove inner ear lesion
30.04
WD
(e)
(a)
30.04
69990
Microsurgery add-on
3.47
N/A
3.47
agree
3.47
72275
Epidurography
0.76
0.83
0.83
(b)
0.76
76005
Fluoroguide for spine inject
0.60
0.60
10.60
agree
0.60
76065
X-rays, bone evaluation
0.28
0.60
0.70
agree
0.70
76090
Mammogram, one breast
0.58
0.64
0.70
agree
0.70
76091
Mammogram, both breasts
0.69
0.76
0.87
agree
0.87
76095
Stereotactic breast biopsy
1.59
3.58
1.59
agree
1.59
88170
Fine needle aspiration
1.27
3.28
1.27
agree
1.27
88171
Fine needle aspiration
1.27
2.63
1.27
agree
1.27
90901
Biofeedback train, any meth
0.41
N/A
0.41
agree
0.41
90911
Biofeedback peri/uro/rectal
0.89
N/A
0.89
agree
0.89
90935
Hemodialysis, one evaluation
1.22
N/A
CPT
CPT
1.22
90937
Hemodialysis, repeated eval
2.11
N/A
CPT
CPT
2.11
90945
Dialysis, one evaluation
1.28
N/A
CPT
CPT
1.28
90947
Dialysis, repeated eval
2.16
N/A
CPT
CPT
2.16
90989
Dialysis training, complete
0.00
N/A
CPT
CPT
0.00
90993
Dialysis training, incompl
0.00
N/A
CPT
CPT
0.00
90997
Hemoperfusion
1.84
N/A
CPT
CPT
1.84
92018
New eye exam & treatment
1.51
N/A
2.50
agree
2.50
93350
Echo transthoracic
0.78
N/A
1.48
agree
1.48
94640
Airway inhalation treatment
0.00
N/A
0.00
agree
0.00
94664
Aerosol or vapor inhalations
0.00
N/A
CPT
CPT
0.00
94665
Aerosol or vapor inhalations
0.00
N/A
CPT
CPT
0.00
96100
Psychological testing
0.00
2.00
(a)
agree
0.00
96105
Assessment of aphasia
0.00
2.00
(a)
agree
0.00
96110
Developmental test, lim
0.00
2.00
(a)
agree
0.00
96115
Neurobehavior status exam
0.00
2.20
(a)
agree
0.00
96117
Neuropsych test battery
0.00
2.20
(a)
agree
0.00
97542
Wheelchair mngmnt training
0.25
0.45
0.45
agree
0.45
99233
Subsequent hospital care
1.51
N/A
1.51
agree
1.51
99273
Confirmatory consultation
1.19
N/A
1.19
agree
1.19
99274
Confirmatory consultation
1.73
N/A
1.73
agree
1.73
99291
Critical care, first hour
3.60
4.00
4.00
agree
4.00
99291
Critical care, first hour
3.60
5.50
4.00
agree
4.00
99291
Critical care, first hour
3.60
N/A
4.00
agree
4.00
99292
Critical care, addl 30 min
1.80
2.00
2.00
agree
2.00
99292
Critical care, addl 30 min
1.80
2.77
2.00
agree
2.00
99292
Critical care, addl 30 min
1.80
N/A
2.00
agree
2.00
99295
Neonatal critical care
16.00
N/A
16.00
agree
16.00
99296
Neonatal critical care
8.00
N/A
8.00
agree
8.00
99297
Neonatal critical care
4.00
N/A
4.00
agree
4.00
99298
Neonatal critical care
2.75
N/A
2.75
agree
2.75
99436
Attendance, birth
1.50
N/A
1.50
agree
1.50
99440
Newborn resuscitation
2.93
N/A
2.93
agree
2.93
G0127
Trim nail(s)
0.11
N/A
(a)
(a)
0.11
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
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
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.
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
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
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
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
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.
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
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
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).
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
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:
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
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.
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