Straight Talk Tuesday

Tuesdays in the month of June, I’m offering some straight talk about a few of the MANY ways in which payment for hyperbaric oxygen therapy is going to change and FAST.  Another issue is that of decreased payment of Physician Supervision for HBOT. The American Medical Association Relative Value Update Committee (AMA RUC) values the “relative work” and practice expense of CPT codes and makes recommendations to CMS. The HBOT physician supervision code (99183) had never been valued by the RUC. In 1994 it was assigned a value by CMS of 2.34 RVUs (relative value units). This code was selected for review in 2014 due to increased utilization (558,912 claims for hyperbaric treatment supervision in 2013).

The process of valuing a code includes a physician survey, defining the practice expense, and a presentation in front of the RUC defending the request for keeping the value unchanged. In order to present to the RUC you have to have a supporting society. Only the American College of Emergency Physicians (ACEP) stepped up to the plate initially. The American College of Surgeons funded the practice expense survey which was sent to about 1000 physicians. Only about 100 answered the survey.

The typical code that comes up for review is decreased about 20%.

Dr. Helen Gelly spearheaded the UHMS response to the RUC. During their analysis, the RUC needed data on the co-morbid conditions of patients undergoing HBOT, the average number of medications they took and the frequency of HBOT “adverse events” (better referred to as “side effects”). The UHMS reached out to the wound center management companies for these data but got no response. Thankfully the US Wound Registry stepped up to the plate and provided the data in about 1 hour—in response to the RUCs urgent demand. Next week I will tell you the rest of the story.