CMS Targets Endoscopy Procedures for Revaluation

October 26, 2012

A systematic re-evaluation of physician payment for endoscopic services is currently underway. This evaluation was set in motion by CMS, which asked the AMA’s Relative Value Update Committee (RUC) to review an extensive number of physician services, including endoscopic procedures. This RUC survey process will have a significant impact on reimbursement for all of us who perform endoscopic procedures.

The GI community is facing a comprehensive review of physician work and practice expense inputs on more than 100 endoscopy codes. Physician work, time and intensity of services directly impact how procedures are “valued” and codes ultimately reimbursed. The process requires that the data for the RUC review comes from surveys completed by physicians, not decided by CMS on an arbitrary basis.

The RUC process cannot work without you.

AGA and ASGE are asking physicians to complete the RUC surveys of endoscopic procedures. During November, we will be surveying the codes for EGD and several esophagoscopy procedures. Your participation is critical to obtaining equitable reimbursement of endoscopic procedures. If a minimum number of responses for each survey are not obtained, CMS could make decisions about our reimbursement without input from gastroenterologists.

I know firsthand that physicians are faced with ever increasing demands for our time, but this is an important opportunity for all of us to have an impact on the future of our profession. Whether you perform routine or more complex procedures, your help is needed.

The RUC is an advisory committee to CMS and is responsible for making relative value recommendations that directly impact the agency’s fee schedule decisions. If our recommendations for endoscopy procedures are not supported by adequate survey data from physicians who perform these procedures, CMS will make the final determination regarding reimbursement of our procedures. Do not forfeit this important opportunity to provide input into the valuation of GI endoscopic services.

Learn more about the RUC surveys and how you can participate. On behalf of my fellow peers and colleagues, I thank you in advance for your help.

— Lawrence R. Kosinski, MD, MBA, AGAF

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