“While participation does not guarantee a given RVU value request, absence from the committee process almost never produces a favorable result,” Dr. Laing says. “Aside from individual CPT code value determinations, the RUC also serves as a vital nexus of communication with other societies, the CMS and the AMA, allowing discussion of broader issues affecting all of medicine.”
CPT code review surveys—Surveys are sent out periodically to ACR members to demonstrate that survey responses truly represent the majority of practitioners’ work for a specific CPT code. Codes are not eligible for RUC valuation if the requisite number of surveys (the minimum threshold depends on national code utilization frequency) are not returned. The submitted responses form the basis for RUC committee debate, Dr. Laing shares.
When rheumatologists need to be surveyed, Ms. Chung coordinates with the AMA by suggesting ACR members who are likely to seek reimbursement for the CPT code up for review. Then a portion of ACR members who fall in this group are invited by email to answer the survey questions.
“This means that every ACR member who receives a RUC survey for a CPT code being considered for valuation or re-valuation should complete it to the best of their ability,” Ms. Chung stresses. She notes that survey language is very specific to reimbursement terminology, which can add to the challenge of answering the survey. She encourages any ACR member who receives a survey to contact the ACR with any questions, because their answer can make a significant difference in the final RVU determination.
Case in Point: CPT Code Review for Diagnostic Ultrasound
Starting in 2021, ACR members were surveyed for several code re-valuations, including for diagnostic ultrasound CPT codes 76881 and 76882. The goal was to present practice expenses for this code, because there were questions about the utilization of the codes and what was being done in practice, Ms. Chung explains. “ACR members became key players in this code set because rheumatology is the largest specialty that uses these codes, representing 25% of Medicare claims data.”
Between 2021 and 2023, Ms. Chung, Dr. Laing and Dr. Huffstutter worked with other physician specialties to communicate to the AMA and, thereby, the CMS on what was required in practice for these codes, spanning from the actual equipment purchasing and maintenance costs to clinician time spent collecting and analyzing ultrasound data for diagnosis.
“We proved these codes and the care they represent are very important to managing care for patients with rheumatic disease, as well as other patients in pain,” Ms. Chung says. For the final RVU determination, CPT code 76881 decreased, but CPT code 76882 increased. “In the big scheme of things, our success with securing an RVU increase for one of these diagnostic ultrasound codes gives us an idea of the advocacy work we can do to make changes in the future.”
