Report to New England Section



Report to New England SectionCRC Meeting – AUA November 2012Numerous important issues were discussed at our fall meeting of the American Urological Association Coding and Reimbursement Committee. This meeting took place November 16th at the AUA headquarters. Since there are confidentiality issues, I am bringing to the group only some of the public issues that will be helpful to practicing urologists.The most relevant topic discussed for the New England Section, and especially for Massachusetts urologists, is about the future ultrasound practice accreditation requirement for continued reimbursement for ultrasound studies. This initiative was started by Blue Cross of Massachusetts. BC/BS wanted all urologists to obtain AIUM accreditation in order to be reimbursed for performing ultrasound studies. However, at the time of this initiative, AIUM (American Institute for Ultrasound in Medicine) did not have ultrasound certification criteria for the urologic practice. Therefore, existing practices have been temporarily grandfathered. The AIUM working with the AUA has developed a certification program of required courses, case log submission and site inspections. The current certification plan entails: AIUM/AUA courses which are a 12 hours video didactic course8 hours of hands on training. 50 cases per year of course logs for 3 years.12 hrs of ultrasound CMEs for 3 years. The target date for accreditation was to be June 2013.The AUA and AIUM are working with BCBS on changing the accreditation date. We feel that this date is not a realistic target date for shutting down non-certified practices. However, make no mistake this is coming and all practices will have to be accredited to continue to be paid for ultrasound. All other National BC/BS payers, as well as other private payers, are looking at Massachusetts. It is the feeling that this will be a national trend. Therefore, the AUA is going to try to focus the education and CME credits on Massachusetts to get AUA/AIUM/MAPU/NEAUA courses and accreditation running here.CPT codes 52332 cystourethroscopy with stent insertion and 52353 ureteroscopy with lithotripsy were identified by CMS as codes performed together more than 75% of the time. Therefore, it has been requested that these two procedures be combined to create a new inclusive CPT code. The current CPT will remain in the CPT book. Other ureteroscopy codes were reviewed by the RUC as potentially misvalued codes. These codes were published in the Medicare Fee Schedule Final Rule. The AUA is going to request that the RUC review the practice expense (supplies, equipment and staff) of certain office procedure codes due to the use of equipment such a flexible cystoscopes, video, complete dilation kits, etc. that increase the costs of the procedures. This approach does not affect the work aspect of the procedure codes. The AUA may solicit information from practices on these increased costs.ICD-10 is progressing though implementation has been delayed until October 1, 2014. The AUA has submitted modifications to some of the section of the diagnosis codes affecting urology. If not adopted for the October 1, 2014 implementation date, the changes will take place on October 1, 2015. Because of some changes to coding guidance on the reporting of 88305 prostate needle biopsy, there is still confusion on the appropriate reporting of 88305 versus G0416 saturation mapping biopsy 1-20 specimens for Medicare. The AUA has warned members that one Medicare insurers (Palmetto) published coding guidance that advised providers that if they report five or more prostate biopsies, use G0416 and if they report four or less prostate biopsies, use 88305. This definition is different than the general urology practice of 10 – 12 biopsies for the routine transrectal prostate biopsy. CMS published a change in the 2013 Final Rule for G0416 to cover 10-20 specimens for the transperineal prostate biopsy approach. There is confusion on the term “saturation” biopsy that could be either transrectal (CPT code 55700) or transperineal (CPT code 55706) approaches, however, the G codes were developed for biopsies are taken with the transperineal approach - with anesthesia and an external template being applied to the perineum for mapping. However, there is still confusion on reporting 88305 for the transrectal ultrasound where urologists are obtaining 10 – 12 biopsies routinely. The AUA has been trying to get clarification on what the change to the Final Rule will mean for reporting 88305 and G0416 for prostate biopsies. We will alert our members when clarification has been obtained.Beers Criteria - Many of us have had patient prescriptions questioned by insurers in elderly patients. These questions consume a lot of MD time as well as office personnel time to get drug approvals. For urology many of these drugs are for OAB as well as urinary antibiotics such as nitrofurantoin. The origin of these issues stems from an article written on The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The AUA is trying to address this.Code Surveys – There was discussion regarding certain procedure codes that information about their current use and work is needed. We may do some informal surveys to get more information.USPSTF – The AUA has drafted a response to the recent PSA recommendations as well as drafting legislation regarding the review process. ................
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