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Pediatric Interventional Cardiology Coding Work Group Part Three

Updated: May 7

The Intra-Procedure and Post-Procedure Segments in a RUC Assessment of Total Procedural Time


Sergio Bartakian, MD, FSCAI, FAAP; Sarosh Batlivala, MD, MSCI; James C. Blankenship, MD, MHCM, MACC, MSCAI; Jeff Delaney, MD, FSCAI; Gurumurthy Hiremath, MD, FACC, FSCAI; Mark Hoyer, MD, FSCAI; Frank Ing, MD, FACC, MSCAI

This is the third article in a series from the PICCW designed to educate providers on coding/billing practices for CCCHD, as well as update the community regarding ongoing projects. Importantly, the reader must understand these topics cover only one component of reimbursement, the physician work RVU. The other two components of the RVU system, practice expense RVU and professional liability RVU, are beyond the scope of this work.[1]


Intra-Procedure Segment

Unlike the pre-procedure and post-procedure segments, the intra-procedure time is fairly straightforward and is generally thought of as the “skin-to-skin” time. In the congenital catheterization lab this begins with you/your surrogate placing hands on the patient, evaluating where to apply local anesthetic and begin the process of obtaining vascular access, including any ultrasound imaging. It concludes, very importantly, not with the sheath out time, rather with the time hemostasis is achieved and a dressing applied.

FIGURE 1 Change in intra-procedure time with increasing complexity exposure over time. The left-most curve reflects estimates of intra-procedure time by operators performing TPVR procedures on simple patients in the early experience. The right-most curve reflects estimates of operators performing TPVR in the larger number of more complex patients at the present time. NOTE: This figure is not based on any specific data set, rather only meant to be a figurative description of the effect of a change in patient population.



The most important concept to understand with estimation of intra-procedure time is that of capturing the “typical” scenario. The CPT®/RUC process generally defines “typical” as the scenario that is encountered in at least 51% of cases. Respondents to a RUC survey must read all of the information provided closely. There will be a vignette at the start of the survey, which will instruct as to what the typical patient is and ask whether the respondent agrees. It is important to bear in mind that the typical patient for each respondent may not necessarily be the same as the typical for the entire specialty. The survey respondent is supposed to be familiar with the procedure for the typical patient described, which may not necessarily be their typical patient. If they have no familiarity with a typical patient described, then they should not complete the survey.


To read the full article, please go to the July 2020 Issue of CCT.

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