The American Medical Association’s (AMA) RVS Update Committee (RUC) and the Current Procedural Terminology Committee (CPT) meet six times per year to review resource costs and code descriptors for provider services. At these meetings, the ACR is represented by several volunteers and staff to provide a voice in shaping Medicare policy for rheumatology. The first half of 2018 has been packed with work for the ACR advisors and staff at both the RUC and CPT.
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RUC Meeting Highlights
At the January 2018 AMA RUC meeting in San Diego, the ACR, along with the American College of Radiology, the Society of Nuclear Medicine and Molecular Imaging and the American College of Nuclear Medicine convened a consensus panel to present the practice expense data for dual-energy X-ray absorptiometry DXA for CPT code 77081. A compelling argument was made on two fronts to request an increase for clinical staff time, total cost of supplies and/or total cost of equipment. First, in the non-facility setting, the dominant provider was previously radiology, but it is now internal medicine. Second, there has been a change in the type of equipment typically used to perform this procedure. Current technology uses general-purpose fan beam units with accompanying computer and software. These units allow for highly accurate and repeatable DXA scanning at extremely low radiation doses.
It was also necessary to present more granular details regarding clinical staff time during the intra-service period when patients are properly positioned on the scan table to obtain an initial scan of the region of interest. The technologist confirms the adequacy of the image (e.g., proper positioning, adequate exposure, etc.). Positioning is compared with any prior study to ensure the patient was similarly positioned, and repeat imaging is performed if needed. The technologist defines the proximal and distal regions for analysis, ensuring that any metal, healed fractures, etc. are excluded. Images and bone mineral density data in report form are prepared for transmission to the picture archiving and communication system for reporting. The survey results and comparison with applicable codes support the recommended value for 77081, which was accepted by the AMA practice expense committee.
Additionally, the ACR RUC advisors are monitoring the work of the RUC’s Research Subcommittee, which is reviewing the existing pre- and postservice time packages, and will recommended new and revised time packages, if deemed necessary.
One key topic being monitored is the committee’s outline on how to define a complex patient, because this will affect whether the current packages need to be updated, as well as how to create non-facility postservice time packages. The work group is reviewing the packages, which include an analysis with the 25th percentile, median and 75th percentile pre- and postservice times, a comparison between the survey times and the final RUC recommendations for past packages with assigned times.