Pediatric Interventional Cardiology Coding Work Group Part Two

The Pre-Procedure Segment in a RUC Assessment of Total Procedural Time

Sergio Bartakian, MD, FSCAI, FAAP; Sarosh P. Batlivala, MD, MSCI; Gurumurthy Hiremath, MD, FACC, FSCAI; Mark H. Hoyer, MD, FSCAI; Frank F. Ing, MD, FACC, MSCAI

This is the second article in a series from the Pediatric Interventional Cardiology Coding Workgroup (PICCW) designed to educate providers on coding/billing practices for Cardiac Catheterization for Congenital Heart Disease (CCCHD), as well as to update the community regarding ongoing projects. Importantly, the reader must understand these topics cover only one component of reimbursement, the physician work Relative Value Units (RVU). The other two components of the RVU system, practice expense RVU and professional liability RVU, are beyond the scope of this work.[1]

TABLE 1 Pre-procedure packages for facility setting[5]

As mentioned last month, once a code application is accepted by the Current Procedural Terminology (CPT®) Panel, a Relative Value Scale Update Committee (RUC) survey is distributed to stakeholder society members via email. The aim of the survey is to gather data on the time and intensity required to perform the proposed work. In the survey, respondents are initially provided a list of existing CPT® codes, from which they are to pick the one that most closely resembles the new code with respect to time, complexity, and intensity. This comparison code is referred to as the Key Reference Service (KRS). Respondents are then asked a series of questions comparing the proposed procedure to that of the KRS. Whereas any questions regarding the technical skill or mental intensity required are purely subjective, time allocation is a very objective means of comparison. The survey will direct respondents to be very precise with respect to how much time they allocate to each segment, and to not simply round off times.

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