# Medicare Program; Five-Year Review of Work Relative Value Units Under the Physician Fee Schedule > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/fr%3A01-14336 ## Record - **Collection:** Federal Register - **Document type:** Notice - **Published:** June 8, 2001 - **Citation:** 66 FR 31028 ## Text 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 Copies: To order copies of the Federal Register containing this document, send your request to: New Orders, Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date of the issue requested and enclose a check or money order payable to the Superintendent of Documents, or enclose your Visa or Master Card number and expiration date. Credit card orders can also be placed by calling the order desk at (202) 512-1800 or by faxing to (202) 512-2250. The cost for each copy is $9. As an alternative, you can view and photocopy the Federal Register document at most libraries designated as Federal Depository Libraries and at many other public and academic libraries throughout the country that receive the Federal Register . This Federal Register document is also available from the Federal Register online database through GPO Access, a service of the U.S. Government Printing Office. The Website address is: http://www.access.gpo.gov/nara/index.html. To assist readers in referencing sections contained in the preamble, we are providing the following table of contents: Table of Contents I. Background A. Legislative History B. Published Changes to the Physician Fee Schedule C. Current Proposed Notice D. The 5-Year Review Process II. Discussion of Comments and Decisions A. Review of Comments B. Discussion of Comments by Clinical Area 1. Vascular Surgery 2. General Surgery/Colon and Rectal Surgery 3. Thoracic Surgery 4. Orthopedic Surgery 5. Ophthalmology 6. Urology 7. Obstetrics/Gynecology a. Specialty Comments b. Other Concerns 8. Gastroenterology 9. Pulmonary Medicine/Critical Care 10. Cardiology 11. Pediatrics 12. Pediatric Surgery 13. Radiology 14. Plastic Surgery C. Other Comments 1. Anesthesia Services 2. Spine Injection Procedures 3. Biofeedback 4. Surgical Management of Burn Wounds 5. Transplantation 6. Arthroscopy Services 7. Wheelchair Management 8. Psychological Testing 9. Podiatric Services D. Other Issues 1. Critical Care Services in a Global Period 2. Codes Referred to CPT 3. Budget Neutrality 4. Calculation of Practice Expense and Malpractice Relative Value Units 5. Nature and Format of Comments on Work Relative Value Units III. Collection of Information Requirements IV. Response to Comments V. Regulatory Impact Analysis Because of the many organizations and terms to which we refer by acronym in this proposed notice, we are listing these acronyms and their corresponding terms in alphabetical order below: AANA Arthroscopy Association of North America AAO American Academy of Opthalmology AAP American Academy of Pediatrics ABA American Burn Association ACG American College of Gastroenterology ACOG American College of Obstetrics and Gynecology ACR American College of Radiology ACS American College of Surgeons AGA American Gastrointestinal Association AMA American Medical Association APMA American Podiatric Medical Association APSA American Pediatric Surgical Association APTA American Physical Therapy Association ASA American Society of Anesthesiologists ASCRS American Society of Colon and Rectal Surgeons ASGE American Society for Gastrointestinal Endoscopy ASPS American Society of Plastic Surgery ASTS American Society for Transplant Surgeons AUA American Urological Association BBA Balanced Budget Act CPT Current procedural terminology CY Calendar year ERCP Endoscopic retrograde cholangio-pancreatography FDA Food and Drug Administration FR Federal Register GAF Geographic adjustment factor GCPI Geographic practice cost index GPO Government Printing Office 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 si [Text truncated at 120,000 characters. The full text is on the page linked above.] --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/fr%3A01-14336. Public record. Not legal advice.