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 Department of Health and Human Services Health Care Financing Administration [HCFA-1170-PN]
RIN 0938-AK56
 AGENCY: Health Care Financing Administration (HCFA), HHS.
 ACTION: Proposed notice.
 SUMMARY: This proposed notice discusses changes to work relative value units (RVUs) affecting payment for physicians' services. Section 1848(c)(2)(B)(i) of the Social Security Act requires that we review RVUs no less often than every 5 years. This is the second review of work RVUs since we implemented the physician fee schedule on January 1, 1992. These work RVUs are proposed to be effective for services furnished beginning January 1, 2002.
 DATES: To be assured of consideration, we must receive comments at the appropriate address, as provided below, no later than 5 p.m. on August 7, 2001.
 ADDRESSES: Mail written comments (1 original and 3 copies) to the following address only: Health Care Financing Administration, Department of Health and Human Services, Attention: HCFA-1170-PN, P.O. Box 8013, Baltimore, MD 21244-8013. Please allow sufficient time for mailed comments to be timely received in the event of delivery delays. If you prefer, you may deliver your written comments by courier (1 original and 3 copies) to one of the following addresses: Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201, or Room C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-8013 Comments mailed to the above addresses may be delayed and received too late to be considered. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. In commenting, please refer to file code HCFA-1170-PN. Comments received timely will be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document at the headquarters of the Health Care Financing Administration, 7500 Security Boulevard, Baltimore, Maryland, on Monday through Friday of each week from 8:30 a.m. to 5 p.m. Please call (410) 786-7197 to make an appointment to view the public comments.
 FOR FURTHER INFORMATION CONTACT: Jim Menas, (410) 786-4507. Rick Ensor, (410) 786-5617. Diane Milstead, (410) 786-3355. Marc Hartstein (Regulatory Impact Analysis), (410) 786-4539.


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                        *http://www.access.gpo.gov/​nara/​index.html.* To assist readers in referencing sections contained in the preamble, we are providing the following table of contents: Table of Contents I. Background A. Legislative History B. Published Changes to the Physician Fee Schedule C. Current Proposed Notice D. The 5-Year Review Process II. Discussion of Comments and Decisions A. Review of Comments B. Discussion of Comments by Clinical Area 1. Vascular Surgery 2. General Surgery/Colon and Rectal Surgery 3. Thoracic Surgery 4. Orthopedic Surgery 5. Ophthalmology 6. Urology 7. Obstetrics/Gynecology a. Specialty Comments b. Other Concerns 8. Gastroenterology 9. Pulmonary Medicine/Critical Care 10. Cardiology 11. Pediatrics 12. Pediatric Surgery 13. Radiology 14. Plastic Surgery C. Other Comments 1. Anesthesia Services 2. Spine Injection Procedures 3. Biofeedback 4. Surgical Management of Burn Wounds 5. Transplantation 6. Arthroscopy Services 7. Wheelchair Management 8. Psychological Testing 9. Podiatric Services D. Other Issues 1. Critical Care Services in a Global Period 2. Codes Referred to CPT 3. Budget Neutrality 4. Calculation of Practice Expense and Malpractice Relative Value Units 5. Nature and Format of Comments on Work Relative Value Units III. Collection of Information Requirements IV. Response to Comments V. Regulatory Impact Analysis Because of the many organizations and terms to which we refer by acronym in this proposed notice, we are listing these acronyms and their corresponding terms in alphabetical order below: AANA Arthroscopy Association of North America AAO American Academy of Opthalmology AAP American Academy of Pediatrics ABA American Burn Association ACG American College of Gastroenterology ACOG American College of Obstetrics and Gynecology ACR American College of Radiology ACS American College of Surgeons AGA American Gastrointestinal Association AMA American Medical Association APMA American Podiatric Medical Association APSA American Pediatric Surgical Association APTA American Physical Therapy Association ASA American Society of Anesthesiologists ASCRS American Society of Colon and Rectal Surgeons ASGE American Society for Gastrointestinal Endoscopy ASPS American Society of Plastic Surgery ASTS American Society for Transplant Surgeons AUA American Urological Association BBA Balanced Budget Act CPT Current procedural terminology CY Calendar year ERCP Endoscopic retrograde cholangio-pancreatography FDA Food and Drug Administration FR 
                        **Federal Register** GAF Geographic adjustment factor GCPI Geographic practice cost index GPO Government Printing Office 
                        ( print page 31029) HCFA Health Care Financing Administration HCPAC Health Care Professionals Advisory Committee HCPCS HCFA Common Procedure Coding System HHS Health and Human Services IWPUT Intra-service work per unit of time MEI Medicare economic index MQSA Mammography Quality Standards Act of 1992 MSA Metropolitan statistical area PE Practice expense PEAC Practice Expense Advisory Committee RFA Regulatory Flexibility Act RIA Regulatory impact analysis RUC [AMA's Specialty Society] Relative [Value] Update Committee RVU Relative value unit STS Society of Thoracic Surgeons SVS Society for Vascular Surgery I. Background A. Legislative History Since January 1, 1992, Medicare has paid for physician services under section 1848 of the Social Security Act (the Act), “Payment for Physicians” Services.” This section contains three major elements, (1) a fee schedule for the payment of physicians' services; (2) a sustainable growth rate for the rates of increase in Medicare expenditures for physicians' services; and (3) limits on the amounts that nonparticipating physicians can charge beneficiaries. The Act requires that payments under the fee schedule be based on national uniform relative value units (RVUs) based on the resources used in furnishing a service. Section 1848(c) of the Act requires that national RVUs be established for physician work, practice expense, and malpractice expense. Section 1848(c)(2)(B)(ii)(II) of the Act provides that adjustments in RVUs may not cause total physician fee schedule payments to differ by more than $20 million from what they would have been had the adjustments not been made. If this tolerance is exceeded, we must make adjustments to the conversion factors (CFs) to preserve budget neutrality. B. Published Changes to the Physician Fee Schedule In the July 2000 proposed rule (65 FR 44177), we listed all of the final rules published through November 1999, relating to updates to the RVUs and revisions to the payment policies under the physician fee schedule. In the November 2000 final rule (65 FR 65376), we finalized the calendar year (CY) 2000 interim physician work RVUs and issued new interim work RVUs for new and revised codes for CY 2001. The final rule also discussed the activities underway with respect to the second 5-year refinement of work RVUs. C. Current Proposed Notice This proposed notice discusses changes to work RVUs affecting payment for physicians' services. Section 1848(c)(2)(B)(i) of the Act requires that we review RVUs no less often than every 5 years. We implemented the physician fee schedule effective for services furnished beginning January 1, 1992: the first 5-year review of work was initiated in December 1994 and was effective for services furnished beginning January 1, 1997. The revisions proposed in this notice are subject to a 60-day public comment period. We will review public comments, make adjustments as appropriate, and include revised values in our physician fee schedule final rule, to be published by November 1, 2001, effective for services furnished beginning January 1, 2002. D. The 5-Year Review Process We initiated the second 5-year review by soliciting public comments on potentially misvalued work RVUs for all services in the 2000 physician fee schedule in our November 2, 1999 final rule (64 FR 59427). To allow sufficient time for recommendations, we provided a 120-day comment period. We included a discussion of the activities underway with respect to the second 5-year refinement of work RVUs in the July 17, 2000 proposed rule (65 FR 44201). We received comments from approximately 30 specialty groups, organizations, and individuals involving over 900 CPT and HCPCS codes. We also received comments on the proposed process for the 5-year review. As we indicated in the November 2, 1999 final rule and in the July 17, 2000 proposed rule, we shared these comments with the AMA Specialty Society Relative Value Update Committee (RUC). The RUC was formed in November 1991 and grew out of a series of discussions between the AMA and major national medical specialty societies. The work of the RUC is supported by the RUC Advisory Committee, which is made up of representatives of 100 specialty societies in the AMA's House of Delegates. The RUC currently makes recommendations to us on RVUs for new and revised CPT codes (hereafter referred to as codes). This process was used during the first 5-year review, and we believe that it was beneficial. We indicated that we believe the perspective of the RUC is helpful because of its experience in recommending RVUs for the codes that have been added to, or revised by, the CPT panel since we implemented the physician fee schedule in 1992. By virtue of its multispecialty membership and consultation with specialty societies, the RUC involves the medical community in formulating its recommendations. For codes used only by non-physician practitioners, the Health Care Professionals Advisory Committee (HCPAC), a companion to the RUC, has made recommendations to us. As we stated in the first 5-year review, we retain the responsibility for analyzing the comments and recommendations, developing the proposed rule, evaluating comments on the proposed rule, and deciding whether to revise RVUs. After we sent the RUC the comments we received on potentially misvalued services, the RUC identified specialty societies interested in making presentations concerning those misvalued services. In making presentations to the RUC, specialty societies compiled data using a standard survey instrument whereby respondents compared the surveyed service with similar “reference” services that have established, agreed upon work values. Respondents were asked to estimate the work for the survey code, the time to perform pre-, intra-, and postservice activities, and the technical skill, risk, and judgement involved with performing the service. Postservice activities were broken down into hospital and office visits and were assigned an appropriate evaluation and management code by the respondent. Each specialty society selected the physician sample that was surveyed. A minimum of 30 responses was required by the RUC for the survey to be considered valid. For this 5-year review, the RUC permitted a specialty society to use a “minisurvey” for some codes if the number of codes a specialty was reviewing was extremely high. These minisurveys required less information from the respondent but were similar in design. Some specialty societies used a “building-block” approach to validate the survey results for surgical services. In constructing the building blocks, a service is divided into “pre-”, “intra-”, and “post-” service components. The preservice component consists of all services furnished before the physician makes the skin incision (for example, preoperative evaluation and scrubbing) 
                        ( print page 31030)
                        the intraservice component consists of the “skin-to-skin” time, and the postservice component includes immediate postsurgery services and subsequent hospital and office visits. Each component (or building block) is then assigned work RVUs. Preservice and intraservice work RVUs are based on time and intensity, and postservice work is based on the specified evaluation and management service for each postoperative visit. These three values are then summed to compute “building-block” work RVUs. The results of the surveys were reviewed and organized by the specialty society and then presented to the RUC. Based on the survey results and a discussion, the RUC developed a recommendation. The RUC used six workgroups to evaluate the codes. Each workgroup evaluated a series of related codes and submitted its report to the full RUC. The RUC then evaluated those reports and sent recommendations to us. Both the workgroups and the RUC evaluated the relative work (time and intensity) for each service compared to other services on the fee schedule. We received recommendations on work RVUs from the RUC for all of the codes we forwarded, with the exception of the anesthesia codes and conscious sedation codes. II. Discussion of Comments and Decisions A. Review of Comments During the comment period for our November 2, 1999 final rule, we received approximately 35 public comments on approximately 900 codes. After review by our medical staff, we forwarded all of the comments we received concerning misvalued services to the RUC. The RUC submitted work RVU recommendations for all of the codes we forwarded with the exception of the anesthesia codes and conscious sedation codes. The RUC used six workgroups to evaluate the codes. Each workgroup evaluated a series of related codes and submitted its report to the full RUC. The RUC then evaluated those reports and sent its recommendations to us. Both the workgroups and the RUC evaluated the relative work (time and intensity) for each service compared to other services on the fee schedule. As discussed below, we further analyzed all of the RUC recommendations; we evaluated both the recommended work RVUs and the rationale for the recommendations. If we had concerns about the application of a particular methodology, we verified that the recommended work RVUs were appropriate by using alternative methodologies. Table 1, Five-Year Review of Work Relative Value Units, lists the codes reviewed during the 5-year review. This table includes the following information: *CPT/HCPCS Code.*
                         This is the CPT or alphanumeric HCPCS code for a service.
                    *Modifier.*
                         A modifier-26 is shown if the work RVUs represent the professional component of the service.
                    *Description.*
                         This is an abbreviated version of the narrative description of the code.
                    *2000 Work RVUs.*
                         The work RVUs that appeared in the November 2, 1999 final rule are shown for each reviewed code.
                    *Requested Work RVUs.*
                         This column identifies the work RVUs requested by the commenting specialty or individual commenter. If we received more than one comment on a code, the code is listed more than once with the recommended RVUs. If the commenters did not recommend specific RVUs, we indicate this by “N/A”. A “WD” (withdrawal) indicates the commenter withdrew the request for review of a code and chose not to pursue review of the code under the 5-year review.
                    *RUC Recommendation.*
                         This column identifies the work RVUs recommended by the RUC. “CPT” indicates that that the RUC referred this code to the AMA CPT Editorial Panel for review and clarification and recommended maintaining the current work RVUs. An “(e)” indicates the commenting specialty withdrew the proposal; therefore, the RUC recommends maintaining the current work RVUs.
                    *HCPAC Recommendation.*
                         This column identifies the work RVUs recommended by the HCPAC. An “(a)” in this column indicates there was no HCPAC recommendation.
                    *HCFA Decision.*
                         This column indicates whether we agreed with the RUC recommendation (“agree”); we are proposing work RVUs higher than the RUC recommendation (“increase”); or we are proposing work RVUs that are less than the RUC recommendation (“decrease”). Codes for which we did not accept the RUC recommendation are discussed in greater detail following Table 1. An “(a)” in this column indicates that in the absence of a RUC recommendation we are proposing to maintain the present work RVUs. A “(b)” in this column indicates that these services were reviewed as part of the July 2000 Multispecialty Refinement Panels for new and/or revised services. (Meetings of Multispecialty Refinement Panels are conducted as needed to allow specialty representatives the opportunity to discuss the comments they submitted on our decisions on new or revised services published in the final rule. The goal of multispecialty refinement panels is to consider the interests of those who commented on the work RVUs against the redistributive effects that would occur in other specialties. Following each discussion of a specific service, panel members were instructed to individually rate the service under discussion. We then used a statistical analysis of these ratings to create final work RVUs for the services under discussion.) A “(d)” indicates there was no HCPAC recommendation. We propose maintaining current work RVUs.
                    *Proposed work RVUs:*
                         This column contains the 2002 proposed work RVUs. The following is a categorization of our proposals as related to the RUC recommended work RVUs from the 5-year review of work RVUs. The RUC supplied us with recommendations on 857 services. We accepted RUC's recommended work RVUs for 792 of the services reviewed and disagreed with RUC's recommended work RVUs for 65 of the services reviewed. This is an acceptance percentage of 92 percent. Of the 65 services for which we did not accept the RUC's recommended work RVUs we increased the work RVUs for 37 services, decreased the work RVUs for 22 services, and rejected the RUC recommendation of an increase for 6 services that had already been reviewed at the Multispecialty Refinement Panel for CY 2000. Additionally, the HCPAC reviewed a total of 12 services as part of the 5-year review. For 5 of the services reviewed, the HCPAC did not offer a recommendation. Of the remaining 7 services reviewed by the HCPAC, we have accepted the HCPAC recommendations. 
 
    1 
 
 Table 1.—Five-Year Review of Work Relative Value Units
CPT/HCPCS 
                                 
                                    code 1
Mod
Descriptor
2000 
                                 work RVU
Requested 
                                 work RVU
RUC 
                                 REC
HCPAC 
                                 REC
HCFA 
                                 decision
Proposed 
                                 work RVU11055

Trim skin lesion
0.27
0.43

(a)
(a)
0.2711056

Trim skin lesion, 2 to 4
0.39
0.61

(a)
(a)
0.3911057

Trim skin lesions, over 4
0.50
0.79

(a)
(a)
0.5011100

Biopsy of skin lesion
0.81
WD
(e)

(a)
0.8111402

Removal of skin lesion
1.61
2.20
1.61

agree
1.6111642

Removal of skin lesion
2.93
3.05
2.93

agree
2.9311642

Removal of skin lesion
2.93
3.87
2.93

agree
2.9311719

Trim nail(s)
0.11
0.17

(a)
(a)
0.1111730

Removal of nail plate
1.13
WD
(e)

(a)
1.1312001

Repair superficial wound(s)
1.70
N/A
CPT

CPT
1.7012002

Repair superficial wound(s)
1.86
N/A
CPT

CPT
1.8612011

Repair superficial wound(s)
1.76
2.37
1.76

agree
1.7613101

Repair of wound or lesion
3.92
5.43
3.92

agree
3.9213131

Repair of wound or lesion
3.79
4.79
3.79

agree
3.7913132

Repair of wound or lesion
5.95
6.95
5.95

agree
5.9515000

Skin graft
4.00
5.95
CPT

CPT
4.0015001

Skin graft add-on
1.00
2.50
CPT

CPT
1.0015100

Skin split graft
9.05
9.05
CPT

CPT
9.0515101

Skin split graft add-on
1.72
1.72
CPT

CPT
1.7215120

Skin split graft
9.83
9.83
CPT

CPT
9.8315121

Skin split graft add-on
2.67
2.67
CPT

CPT
2.6715350

Skin homograft
4.00
4.00
CPT

CPT
4.0015351

Skin homograft add-on
1.00
1.00
CPT

CPT
1.0015400

Skin heterograft
4.00
4.00
CPT

CPT
4.0015401

Skin heterograft add-on
1.00
1.00
CPT

CPT
1.0017000

Destroy benign/premal lesion
0.60
WD
(e)

(a)
0.6017003

Destroy lesions, 2-14
0.15
WD
(e)

(a)
0.1517004

Destroy lesions, 15 or more
2.79
WD
(e)

(a)
2.7919000

Drainage of breast lesion
0.84
1.27
0.84

agree
0.8419100

Biopsy of breast
1.27
3.88
1.27

agree
1.2719125

Excision, breast lesion
6.06
9.00
6.06

agree
6.0619160

Removal of breast tissue
5.99
8.38
5.99

agree
5.9919162

Remove breast tissue, nodes
13.53
15.68
13.53

agree
13.5319240

Removal of breast
16.00
18.87
16.00

agree
16.0020205

Deep muscle biopsy
2.35
3.42
CPT

CPT
2.3520245

Bone biopsy, excisional
3.95
7.97
8.50

decrease
7.7820600

Drain/inject, joint/bursa
0.66
WD
(e)

(a)
0.6620605

Drain/inject, joint/bursa
0.68
WD
(e)

(a)
0.6821740

Reconstruction of sternum
16.50
21.00
CPT

CPT
16.5021800

Treatment of rib fracture
0.96
1.77
0.96

agree
0.9623076

Removal of shoulder lesion
7.63
13.40
CPT

CPT
7.6323472

Reconstruct shoulder joint
16.92
21.27
21.10

agree
21.1023485

Revision of collar bone
13.43
18.73
13.43

agree
13.4323585

Treat scapula fracture
8.96
11.46
8.96

agree
8.9623615

Treat humerus fracture
9.35
15.85
9.35

agree
9.3523630

Treat humerus fracture
7.35
12.45
7.35

agree
7.3523680

Treat dislocation/fracture
10.06
13.10
10.06

agree
10.0624076

Remove arm/elbow lesion
6.30
10.20
CPT

CPT
6.3024435

Repair humerus with graft
13.17
20.36
13.17

agree
13.1724545

Treat humerus fracture
10.46
12.26
10.46

agree
10.4625076

Removal of forearm lesion
4.92
12.96
CPT

CPT
4.9226562

Repair of web finger
9.68
12.56
15.00

agree
15.0027048

Remove hip/pelvis lesion
6.25
13.01
CPT

CPT
6.2527075

Extensive hip surgery
17.23
28.52
35.00

agree
35.0027077

Extensive hip surgery
23.13
30.00
40.00

agree
40.0027216

Treat pelvic ring fracture
15.19
25.00
15.19

agree
15.1927217

Treat pelvic ring fracture
14.11
17.11
14.11

agree
14.1127218

Treat pelvic ring fracture
20.15
22.15
20.15

agree
20.1527226

Treat hip wall fracture
14.91
19.91
14.91

agree
14.9127236

Treat thigh fracture
15.60
17.60
15.60

agree
15.6027280

Fusion of sacroiliac joint
13.39
21.00
13.39

agree
13.3927282

Fusion of pubic bones
11.34
21.66
11.34

agree
11.3427284

Fusion of hip joint
16.76
20.12
23.45

agree
23.4527328

Removal of thigh lesion
5.57
8.70
CPT

CPT
5.57( print page 31032)27472

Repair/graft of thigh
17.72
23.62
17.72

agree
17.7227513

Treatment of thigh fracture
17.92
20.92
17.92

agree
17.9227536

Treat knee fracture
15.65
19.00
15.65

agree
15.6527590

Amputate leg at thigh
12.03
15.52
12.03

agree
12.0327619

Remove lower leg lesion
8.40
10.02
CPT

CPT
8.4027724

Repair/graft of tibia
14.99
19.34
18.20

agree
18.2027822

Treatment of ankle fracture
9.20
10.68
11.00

agree
11.0027823

Treatment of ankle fracture
11.80
13.27
13.00

agree
13.0027828

Treat lower leg fracture
16.23
19.00
16.23

agree
16.2328299

Correction of bunion
8.88
11.90
9.18

agree
9.1828322

Repair of metatarsals
8.34
13.26
8.34

agree
8.3428420

Treat/graft heel fracture
16.64
23.52
16.64

agree
16.6428445

Treat ankle fracture
9.33
15.97
15.62

agree
15.6228705

Fusion of foot bones
15.21
20.46
18.80

agree
18.8029450

Application of leg cast
1.02
3.00
2.08

agree
2.0829450

Application of leg cast
1.02
N/A
2.08

agree
2.0829881

Knee arthroscopy/surgery
7.76
WD
(e)

(a)
7.7629883

Knee arthroscopy/surgery
9.46
12.00
11.05

agree
11.0529889

Knee arthroscopy/surgery
15.13
16.68
16.00

agree
16.0029889

Knee arthroscopy/surgery
15.13
18.47
16.00

agree
16.0031600

Incision of windpipe
3.62
6.42
7.18

agree
7.1831622

Dx bronchoscope/wash
2.78
4.17
2.78

agree
2.7831622

Dx bronchoscope/wash
2.78
N/A
2.78

agree
2.7831625

Bronchoscopy with biopsy
3.37
N/A
3.37

agree
3.3731645

Bronchoscopy, clear airways
3.16
N/A
3.16

agree
3.1632000

Drainage of chest
1.54
2.88
1.54

agree
1.5432000

Drainage of chest
1.54
N/A
1.54

agree
1.5432005

Treat lung lining chemically
2.19
N/A
2.19

agree
2.1932020

Insertion of chest tube
3.98
N/A
3.98

agree
3.9832035

Exploration of chest
8.67
N/A
8.67

agree
8.6732095

Biopsy through chest wall
8.36
N/A
8.36

agree
8.3632100

Exploration/biopsy of chest
11.84
N/A
15.24

agree
15.2432110

Explore/repair chest
13.62
N/A
23.00

agree
23.0032220

Release of lung
19.27
N/A
24.00

agree
24.0032225

Partial release of lung
13.96
N/A
13.96

agree
13.9632320

Free/remove chest lining
20.54
N/A
24.00

agree
24.0032440

Removal of lung
21.02
35.08
25.00

agree
25.0032440

Removal of lung
21.02
N/A
25.00

agree
25.0032480

Partial removal of lung
18.32
27.17
23.75

agree
23.7532480

Partial removal of lung
18.32
N/A
23.75

agree
23.7532482

Bilobectomy
19.71
N/A
25.00

agree
25.0032491

Lung volume reduction
21.25
N/A
21.25

agree
21.2532500

Partial removal of lung
14.30
N/A
22.00

agree
22.0032520

Remove lung & revise chest
21.68
N/A
21.68

agree
21.6832602

Thoracoscopy, diagnostic
5.96
N/A
5.96

agree
5.9632651

Thoracoscopy, surgical
12.91
N/A
12.91

agree
12.9132652

Thoracoscopy, surgical
18.66
N/A
18.66

agree
18.6632655

Thoracoscopy, surgical
13.10
N/A
13.10

agree
13.1032657

Thoracoscopy, surgical
13.65
N/A
13.65

agree
13.6533207

Insertion of heart pacemaker
8.04
WD
(e)

(a)
8.0433234

Removal of pacemaker system
7.82
N/A
7.82

agree
7.8233235

Removal of pacemaker electrode
9.40
N/A
9.40

agree
9.4033400

Repair of aortic valve
25.34
N/A
28.50

agree
28.5033405

Replacement of aortic valve
30.61
N/A
35.00

agree
35.0033406

Replacement of aortic valve
32.30
N/A
37.50

agree
37.5033410

Replacement of aortic valve
32.46
N/A
32.46

agree
32.4633411

Replacement of aortic valve
32.47
N/A
36.25

agree
36.2533412

Replacement of aortic valve
34.79
N/A
42.00

agree
42.0033413

Replacement of aortic valve
35.24
N/A
43.50

agree
43.5033415

Revision, subvalvular tissue
27.15
N/A
27.15

agree
27.1533425

Repair of mitral valve
27.00
N/A
27.00

agree
27.0033426

Repair of mitral valve
31.03
N/A
33.00

agree
33.0033427

Repair of mitral valve
33.72
N/A
40.00

agree
40.0033430

Replacement of mitral valve
31.43
N/A
33.50

agree
33.5033468

Revision of tricuspid valve
30.12
N/A
30.12

agree
30.1233475

Replacement, pulmonary valve
28.41
N/A
33.00

agree
33.00( print page 31033)33506

Repair artery, translocation
26.71
N/A
35.50

agree
35.5033510

CABG, vein, single
25.12
N/A
29.00

agree
29.0033511

CABG, vein, two
27.40
N/A
30.00

agree
30.0033512

CABG, vein, three
29.67
N/A
31.80

agree
31.8033513

CABG, vein, four
31.95
N/A
32.00

agree
32.0033514

CABG, vein, five
35.00
N/A
32.75

agree
32.7533516

Cabg, vein, six or more
37.40
N/A
35.00

agree
35.0033517

CABG, artery-vein, single
2.57
N/A
2.57

agree
2.5733518

CABG, artery-vein, two
4.85
N/A
4.85

agree
4.8533519

CABG, artery-vein, three
7.12
N/A
7.12

agree
7.1233521

CABG, artery-vein, four
9.40
N/A
9.40

agree
9.4033522

CABG, artery-vein, five
11.67
N/A
11.67

agree
11.6733523

Cabg, art-vein, six or more
13.95
N/A
13.95

agree
13.9533530

Coronary artery, bypass/reop
5.86
N/A
5.86

agree
5.8633533

CABG, arterial, single
25.83
N/A
30.00

agree
30.0033534

CABG, arterial, two
28.82
N/A
32.20

agree
32.2033535

CABG, arterial, three
31.81
N/A
34.50

agree
34.5033536

Cabg, arterial, four or more
34.79
N/A
37.50

agree
37.5033611

Repair double ventricle
32.30
N/A
34.00

agree
34.0033612

Repair double ventricle
33.26
N/A
35.00

agree
35.0033615

Repair, simple fontan
32.06
N/A
34.00

agree
34.0033617

Repair, modified fontan
34.03
N/A
37.00

agree
37.0033619

Repair single ventricle
37.57
N/A
45.00

agree
45.0033641

Repair heart septum defect
21.39
N/A
21.39

agree
21.3933660

Repair of heart defects
25.54
N/A
30.00

agree
30.0033670

Repair of heart chambers
32.73
N/A
35.00

agree
35.0033681

Repair heart septum defect
27.67
N/A
30.61

agree
30.6133694

Repair of heart defects
31.73
N/A
34.00

agree
34.0033697

Repair of heart defects
33.71
N/A
36.00

agree
36.0033730

Repair heart-vein defect(s)
31.67
N/A
34.25

agree
34.2533750

Major vessel shunt
21.41
N/A
21.41

agree
21.4133767

Major vessel shunt
24.50
N/A
24.50

agree
24.5033770

Repair great vessels defect
33.29
N/A
37.00

agree
37.0033778

Repair great vessels defect
35.82
N/A
40.00

agree
40.0033780

Repair great vessels defect
36.94
N/A
41.75

agree
41.7533786

Repair arterial trunk
34.84
N/A
39.00

agree
39.0033820

Revise major vessel
16.29
N/A
16.29

agree
16.2933840

Remove aorta constriction
20.63
N/A
20.63

agree
20.6333860

Ascending aortic graft
33.96
N/A
38.00

agree
38.0033861

Ascending aortic graft
34.52
N/A
42.00

agree
42.0033863

Ascending aortic graft
36.47
N/A
45.00

agree
45.0033870

Transverse aortic arch graft
40.31
N/A
44.00

agree
44.0033875

Thoracic aortic graft
33.06
N/A
CPT

CPT
33.0633877

Thoracoabdominal graft
42.60
N/A
CPT

CPT
42.6033917

Repair pulmonary artery
24.50
N/A
24.50

agree
24.5033919

Repair pulmonary atresia
32.67
N/A
40.00

agree
40.0033945

Transplantation of heart
42.10
N/A
42.10

agree
42.1034001

Removal of artery clot
12.91
WD
(e)

(a)
12.9134101

Removal of artery clot
9.97
N/A
10.00

agree
10.0034111

Removal of arm artery clot
8.07
N/A
10.00

agree
10.0034151

Removal of artery clot
16.86
27.51
25.00

agree
25.0034151

Removal of artery clot
16.86
28.00
25.00

agree
25.0034201

Removal of artery clot
9.13
10.40
10.03

agree
10.0334201

Removal of artery clot
9.13
10.58
10.03

agree
10.0334203

Removal of leg artery clot
12.21
14.99
16.50

agree
16.5034203

Removal of leg artery clot
12.21
16.50
16.50

agree
16.5034401

Removal of vein clot
12.86
26.63
25.00

agree
25.0034401

Removal of vein clot
12.86
28.00
25.00

agree
25.0034421

Removal of vein clot
9.93
15.75
12.00

agree
12.0034421

Removal of vein clot
9.93
15.94
12.00

agree
12.0034451

Removal of vein clot
14.44
29.05
27.00

agree
27.0034451

Removal of vein clot
14.44
30.00
27.00

agree
27.0034490

Removal of vein clot
7.60
N/A
9.86

agree
9.8634501

Repair valve, femoral vein
10.93
N/A
16.00

agree
16.0034510

Transposition of vein valve
13.25
N/A
18.95

agree
18.9534520

Cross-over vein graft
13.74
N/A
17.95

agree
17.95( print page 31034)34530

Leg vein fusion
17.61
N/A
16.64

agree
16.6435011

Repair defect of artery
11.65
14.10
18.00

agree
18.0035011

Repair defect of artery
11.65
18.00
18.00

agree
18.0035013

Repair artery rupture, arm
17.40
15.38
22.00

agree
22.0035013

Repair artery rupture, arm
17.40
20.00
22.00

agree
22.0035045

Repair defect of arm artery
11.26
11.05
17.57

agree
17.5735045

Repair defect of arm artery
11.26
16.50
17.57

agree
17.5735081

Repair defect of artery
28.01
33.13
28.01

agree
28.0135082

Repair artery rupture, aorta
36.35
37.00
38.50

agree
38.5035082

Repair artery rupture, aorta
36.35
41.80
38.50

agree
38.5035092

Repair artery rupture, aorta
38.39
50.00
45.00

agree
45.0035092

Repair artery rupture, aorta
38.39
58.61
45.00

agree
45.0035103

Repair artery rupture, groin
33.57
41.00
40.50

agree
40.5035103

Repair artery rupture, groin
33.57
44.12
40.50

agree
40.5035111

Repair defect of artery
16.43
23.24
25.00

agree
25.0035111

Repair defect of artery
16.43
28.00
25.00

agree
25.0035112

Repair artery rupture,spleen
18.69
29.20
30.00

agree
30.0035112

Repair artery rupture,spleen
18.69
30.00
30.00

agree
30.0035121

Repair defect of artery
25.99
30.29
30.00

agree
30.0035121

Repair defect of artery
25.99
32.00
30.00

agree
30.0035122

Repair artery rupture, belly
33.45
36.83
35.00

agree
35.0035122

Repair artery rupture, belly
33.45
37.00
35.00

agree
35.0035131

Repair defect of artery
18.55
23.15
25.00

agree
25.0035131

Repair defect of artery
18.55
28.00
25.00

agree
25.0035132

Repair artery rupture, groin
21.95
30.00
30.00

agree
30.0035132

Repair artery rupture, groin
21.95
30.54
30.00

agree
30.0035141

Repair defect of artery
14.46
19.38
20.00

agree
20.0035141

Repair defect of artery
14.46
20.00
20.00

agree
20.0035142

Repair artery rupture, thigh
15.86
23.36
23.30

agree
23.3035142

Repair artery rupture, thigh
15.86
25.00
23.30

agree
23.3035151

Repair defect of artery
17.00
20.26
22.64

agree
22.6435151

Repair defect of artery
17.00
22.00
22.64

agree
22.6435152

Repair artery rupture, knee
16.70
24.98
25.62

agree
25.6235152

Repair artery rupture, knee
16.70
27.50
25.62

agree
25.6235182

Repair blood vessel lesion
17.74
N/A
30.00

agree
30.0035184

Repair blood vessel lesion
12.25
N/A
18.00

agree
18.0035189

Repair blood vessel lesion
18.43
N/A
28.00

agree
28.0035190

Repair blood vessel lesion
12.75
N/A
12.75

agree
12.7535201

Repair blood vessel lesion
9.99
12.74
16.14

agree
16.1435201

Repair blood vessel lesion
9.99
18.35
16.14

agree
16.1435206

Repair blood vessel lesion
9.25
N/A
13.25

agree
13.2535221

Repair blood vessel lesion
16.42
26.00
24.39

agree
24.3935221

Repair blood vessel lesion
16.42
28.95
24.39

agree
24.3935226

Repair blood vessel lesion
9.06
14.00
14.50

agree
14.5035226

Repair blood vessel lesion
9.06
15.82
14.50

agree
14.5035231

Repair blood vessel lesion
12.00
15.64
20.00

agree
20.0035231

Repair blood vessel lesion
12.00
18.90
20.00

agree
20.0035236

Repair blood vessel lesion
10.54
12.85
17.11

agree
17.1135236

Repair blood vessel lesion
10.54
18.00
17.11

agree
17.1135246

Repair blood vessel lesion
19.84
26.00
26.45

agree
26.4535246

Repair blood vessel lesion
19.84
N/A
26.45

agree
26.4535251

Repair blood vessel lesion
17.49
31.00
30.20

agree
30.2035251

Repair blood vessel lesion
17.49
34.04
30.20

agree
30.2035256

Repair blood vessel lesion
11.38
N/A
18.36

agree
18.3635261

Repair blood vessel lesion
11.63
15.51
17.80

agree
17.8035261

Repair blood vessel lesion
11.63
18.90
17.80

agree
17.8035266

Repair blood vessel lesion
10.30
15.79
14.91

agree
14.9135266

Repair blood vessel lesion
10.30
17.00
14.91

agree
14.9135276

Repair blood vessel lesion
18.75
22.00
24.25

agree
24.2535276

Repair blood vessel lesion
18.75
N/A
24.25

agree
24.2535281

Repair blood vessel lesion
16.48
29.00
28.00

agree
28.0035281

Repair blood vessel lesion
16.48
32.01
28.00

agree
28.0035286

Repair blood vessel lesion
11.87
N/A
16.16

agree
16.1635311

Rechanneling of artery
23.85
30.00
27.00

agree
27.0035311

Rechanneling of artery
23.85
N/A
27.00

agree
27.0035321

Rechanneling of artery
11.97
16.47
16.00

agree
16.00( print page 31035)35321

Rechanneling of artery
11.97
18.35
16.00

agree
16.0035331

Rechanneling of artery
23.52
24.81
26.20

agree
26.2035331

Rechanneling of artery
23.52
28.01
26.20

agree
26.2035351

Rechanneling of artery
20.11
24.09
23.00

agree
23.0035351

Rechanneling of artery
20.11
25.50
23.00

agree
23.0035355

Rechanneling of artery
16.09
20.01
18.50

agree
18.5035355

Rechanneling of artery
16.09
20.75
18.50

agree
18.5035361

Rechanneling of artery
23.59
29.08
28.20

agree
28.2035361

Rechanneling of artery
23.59
30.00
28.20

agree
28.2035363

Rechanneling of artery
24.66
32.00
30.20

agree
30.2035363

Rechanneling of artery
24.66
35.67
30.20

agree
30.2035371

Rechanneling of artery
11.64
12.97
14.72

agree
14.7235371

Rechanneling of artery
11.64
17.75
14.72

agree
14.7235372

Rechanneling of artery
13.56
18.04
18.00

agree
18.0035372

Rechanneling of artery
13.56
19.53
18.00

agree
18.0035381

Rechanneling of artery
15.81
N/A
CPT

CPT
15.8135511

Artery bypass graft
16.83
19.75
21.20

agree
21.2035511

Artery bypass graft
16.83
21.50
21.20

agree
21.2035518

Artery bypass graft
15.42
18.59
21.20

agree
21.2035518

Artery bypass graft
15.42
23.00
21.20

agree
21.2035521

Artery bypass graft
16.17
20.46
22.20

agree
22.2035521

Artery bypass graft
16.17
25.25
22.20

agree
22.2035526

Artery bypass graft
20.00
30.00
29.95

agree
29.9535526

Artery bypass graft
20.00
N/A
29.95

agree
29.9535531

Artery bypass graft
25.61
33.62
36.20

agree
36.2035531

Artery bypass graft
25.61
38.00
36.20

agree
36.2035533

Artery bypass graft
20.52
28.00
28.00

agree
28.0035533

Artery bypass graft
20.52
29.99
28.00

agree
28.0035536

Artery bypass graft
23.11
25.33
31.70

agree
31.7035536

Artery bypass graft
23.11
33.00
31.70

agree
31.7035541

Artery bypass graft
25.80
N/A
CPT

CPT
25.8035546

Artery bypass graft
25.54
N/A
CPT

CPT
25.5435551

Artery bypass graft
26.67
N/A
CPT

CPT
26.6735556

Artery bypass graft
21.76
24.50
21.76

agree
21.7635556

Artery bypass graft
21.76
24.50
21.76

agree
21.7635558

Artery bypass graft
14.04
22.00
21.20

agree
21.2035558

Artery bypass graft
14.04
22.08
21.20

agree
21.2035560

Artery bypass graft
23.56
28.19
32.00

agree
32.0035560

Artery bypass graft
23.56
35.50
32.00

agree
32.0035563

Artery bypass graft
15.14
24.00
24.20

agree
24.2035563

Artery bypass graft
15.14
25.00
24.20

agree
24.2035565

Artery bypass graft
15.14
23.65
23.20

agree
23.2035565

Artery bypass graft
15.14
24.00
23.20

agree
23.2035571

Artery bypass graft
18.58
23.65
24.06

agree
24.0635571

Artery bypass graft
18.58
26.92
24.06

agree
24.0635582

Vein bypass graft
27.13
N/A
CPT

CPT
27.1335587

Vein bypass graft
19.05
24.47
24.75

agree
24.7535587

Vein bypass graft
19.05
27.00
24.75

agree
24.7535621

Artery bypass graft
14.54
16.53
20.00

agree
20.0035621

Artery bypass graft
14.54
21.50
20.00

agree
20.0035623

Bypass graft, not vein
16.62
17.62
24.00

agree
24.0035623

Bypass graft, not vein
16.62
25.75
24.00

agree
24.0035626

Artery bypass graft
23.63
27.58
27.75

agree
27.7535626

Artery bypass graft
23.63
30.00
27.75

agree
27.7535631

Artery bypass graft
24.60
32.51
34.00

agree
34.0035631

Artery bypass graft
24.60
36.00
34.00

agree
34.0035636

Artery bypass graft
22.46
27.32
29.50

agree
29.5035636

Artery bypass graft
22.46
36.00
29.50

agree
29.5035641

Artery bypass graft
24.57
N/A
CPT

CPT
24.5735646

Artery bypass graft
25.81
N/A
CPT

CPT
25.8135650

Artery bypass graft
14.36
15.74
19.00

agree
19.0035650

Artery bypass graft
14.36
19.80
19.00

agree
19.0035654

Artery bypass graft
18.61
23.54
25.00

agree
25.0035654

Artery bypass graft
18.61
26.00
25.00

agree
25.0035661

Artery bypass graft
13.18
17.89
19.00

agree
19.0035661

Artery bypass graft
13.18
19.53
19.00

agree
19.00( print page 31036)35663

Artery bypass graft
14.17
20.90
22.00

agree
22.0035663

Artery bypass graft
14.17
23.00
22.00

agree
22.0035665

Artery bypass graft
15.40
19.84
21.00

agree
21.0035665

Artery bypass graft
15.40
22.00
21.00

agree
21.0035666

Artery bypass graft
19.19
20.00
22.19

agree
22.1935666

Artery bypass graft
19.19
22.00
22.19

agree
22.1935671

Artery bypass graft
14.80
17.80
19.33

agree
19.3335671

Artery bypass graft
14.80
24.00
19.33

agree
19.3335701

Exploration, carotid artery
5.55
9.38
8.50

agree
8.5035701

Exploration, carotid artery
5.55
15.00
8.50

agree
8.5035721

Exploration, femoral artery
5.28
N/A
7.18

agree
7.1835741

Exploration popliteal artery
5.37
N/A
8.00

agree
8.0035840

Explore abdominal vessels
9.77
N/A
CPT

CPT
9.7735860

Explore limb vessels
5.55
N/A
CPT

CPT
5.5535905

Excision, graft, thorax
18.19
32.00
31.25

agree
31.2535905

Excision, graft, thorax
18.19
N/A
31.25

agree
31.2535907

Excision, graft, abdomen
19.24
37.33
35.00

agree
35.0035907

Excision, graft, abdomen
19.24
40.00
35.00

agree
35.0036400

Drawing blood
0.18
N/A
0.38

decrease
0.1836405

Drawing blood
0.18
N/A
0.32

decrease
0.1836406

Drawing blood
0.18
N/A
CPT

CPT
0.1836489

Insertion of catheter, vein
1.22
2.75
2.50

agree
2.5036489

Insertion of catheter, vein
1.22
3.41
2.50

agree
2.5036520

Plasma and/or cell exchange
1.74
N/A
CPT

CPT
1.7436533

Insertion of access device
5.32
5.28
CPT

CPT
5.3236534

Revision of access device
2.80
5.15
CPT

CPT
2.8036535

Removal of access device
2.27
3.89
CPT

CPT
2.2736600

Withdrawal of arterial blood
0.32
WD
(e)

(a)
0.3236620

Insertion catheter, artery
1.15
2.25
CPT

CPT
1.1536625

Insertion catheter, artery
2.11
2.65
2.11

agree
2.1136822

Insertion of cannula(s)
5.42
19.00
5.42

agree
5.4237565

Ligation of neck vein
4.44
9.01
10.88

agree
10.8837565

Ligation of neck vein
4.44
14.50
10.88

agree
10.8837600

Ligation of neck artery
4.57
9.19
11.25

agree
11.2537600

Ligation of neck artery
4.57
14.00
11.25

agree
11.2537605

Ligation of neck artery
6.19
11.85
13.11

agree
13.1137605

Ligation of neck artery
6.19
17.50
13.11

agree
13.1137609

Temporal artery procedure
2.30
3.38
3.00

agree
3.0037609

Temporal artery procedure
2.30
N/A
3.00

agree
3.0037615

Ligation of neck artery
5.73
12.31
CPT

CPT
5.7337615

Ligation of neck artery
5.73
18.00
CPT

CPT
5.7337617

Ligation of abdomen artery
15.95
N/A
22.06

agree
22.0637618

Ligation of extremity artery
4.84
N/A
CPT

CPT
4.8437650

Revision of major vein
5.13
N/A
7.80

agree
7.8037660

Revision of major vein
10.61
N/A
21.00

agree
21.0037700

Revise leg vein
3.73
N/A
CPT

CPT
3.7337720

Removal of leg vein
5.66
10.71
CPT

CPT
5.6637730

Removal of leg veins
7.33
N/A
CPT

CPT
7.3337735

Removal of leg veins/lesion
10.53
N/A
CPT

CPT
10.5337760

Revision of leg veins
10.47
N/A
CPT

CPT
10.4737785

Revision secondary varicosity
3.84
N/A
CPT

CPT
3.8438100

Removal of spleen, total
13.01
14.70
14.50

agree
14.5038100

Removal of spleen, total
13.01
16.21
14.50

agree
14.5038101

Removal of spleen, partial
13.74
14.79
15.31

agree
15.3138115

Repair of ruptured spleen
14.19
15.55
15.82

agree
15.8238300

Drainage, lymph node lesion
1.53
1.01
1.99

agree
1.9938305

Drainage, lymph node lesion
4.61
6.59
6.00

agree
6.0038308

Incision of lymph channels
4.95
7.35
6.45

agree
6.4538500

Biopsy/removal, lymph nodes
2.88
3.29
3.75

agree
3.7538500

Biopsy/removal, lymph nodes
2.88
4.58
3.75

agree
3.7538510

Biopsy/removal, lymph nodes
4.14
6.28
6.43

agree
6.4338520

Biopsy/removal, lymph nodes
5.12
6.93
6.67

agree
6.6738525

Biopsy/removal, lymph nodes
4.66
5.30
6.07

agree
6.0738530

Biopsy/removal, lymph nodes
6.13
9.58
7.98

agree
7.9838571

Laparoscopy, lymphadenectomy
12.38
19.84
12.38

agree
12.3838572

Laparoscopy, lymphadenectomy
14.32
23.17
16.59

agree
16.59( print page 31037)38740

Remove armpit lymph nodes
6.77
10.68
8.42

increase
10.0238745

Remove armpit lymph nodes
8.84
12.78
11.00

increase
13.0038746

Remove thoracic lymph nodes
4.39
N/A
4.89

agree
4.8938760

Remove groin lymph nodes
8.74
11.35
10.88

increase
12.9438765

Remove groin lymph nodes
16.06
18.77
19.98

agree
19.9838780

Remove abdomen lymph nodes
16.59
N/A
16.59

agree
16.5939010

Exploration of chest
11.79
N/A
11.79

agree
11.7939220

Removal chest lesion
17.42
N/A
17.42

agree
17.4239400

Visualization of chest
5.61
N/A
5.61

agree
5.6139503

Repair of diaphragm hernia
34.85
122.75
95.00

decrease
34.8542205

Reconstruct cleft palate
9.59
12.00
13.29

agree
13.2943107

Removal of esophagus
28.79
N/A
40.00

agree
40.0043112

Removal of esophagus
31.22
N/A
43.50

agree
43.5043117

Partial removal of esophagus
30.02
N/A
40.00

agree
40.0043122

Parital removal of esophagus
29.11
N/A
40.00

agree
40.0043215

Esophagus endoscopy
2.60
4.91
CPT

CPT
2.6043217

Esophagus endoscopy
2.90
3.63
2.90

agree
2.9043219

Esophagus endoscopy
2.80
3.50
3.18

decrease
2.8043228

Esoph endoscopy, ablation
3.77
4.72
3.77

agree
3.7743239

Upper GI endoscopy, biopsy
2.69
2.96
2.87

decrease
2.6943239

Upper GI endoscopy, biopsy
2.69
3.79
2.87

decrease
2.6943244

Upper GI endoscopy/ligation
4.59
5.05
5.05

decrease
4.5943246

Place gastrostomy tube
4.33
4.76
4.33

agree
4.3343246

Place gastrostomy tube
4.33
5.04
4.33

agree
4.3343247

Operative upper GI endoscopy
3.39
4.51
3.59

decrease
3.3943249

Esoph endoscopy, dilation
2.90
5.01
3.35

decrease
2.9043251

Operative upper GI endoscopy
3.70
4.44
3.70

agree
3.7043255

Operative upper GI endoscopy
4.40
5.40
4.82

decrease
4.4043258

Operative upper GI endoscopy
4.55
5.01
4.55

agree
4.5543259

Endoscopic ultrasound exam
4.89
N/A
8.59

decrease
4.8943263

Endo cholangiopancreatograph
6.19
7.12
7.29

decrease
6.1943265

Endo cholangiopancreatograph
8.90
N/A
10.02

decrease
8.9043269

Endo cholangiopancreatograph
6.04
7.50
8.21

decrease
6.0443305

Repair esophagus and fistula
17.15
WD
(e)

(a)
17.1543310

Repair of esophagus
25.39
50.50
CPT

CPT
25.3943312

Repair esophagus and fistula
28.42
56.75
CPT

CPT
28.4243320

Fuse esophagus & stomach
16.07
26.45
19.93

agree
19.9343324

Revise esophagus & stomach
16.58
17.75
20.57

agree
20.5743325

Revise esophagus & stomach
16.17
21.65
20.06

agree
20.0643326

Revise esophagus & stomach
15.91
20.53
19.74

agree
19.7443330

Repair of esophagus
15.94
15.44
19.77

agree
19.7743331

Repair of esophagus
16.23
17.60
20.13

agree
20.1343340

Fuse esophagus & intestine
15.81
26.72
19.61

agree
19.6143341

Fuse esophagus & intestine
16.81
29.07
20.85

agree
20.8543350

Surgical opening, esophagus
12.72
32.97
15.78

agree
15.7843351

Surgical opening, esophagus
14.79
31.92
18.35

agree
18.3543352

Surgical opening, esophagus
12.30
25.47
15.26

agree
15.2643360

Gastrointestinal repair
28.78
61.17
35.70

agree
35.7043361

Gastrointestinal repair
32.65
65.83
40.50

agree
40.5043400

Ligate esophagus veins
17.09
29.96
21.20

agree
21.2043401

Esophagus surgery for veins
17.81
34.94
22.09

agree
22.0943405

Ligate/staple esophagus
16.13
36.67
20.01

agree
20.0143410

Repair esophagus wound
10.86
13.65
13.47

agree
13.4743415

Repair esophagus wound
17.06
30.45
25.00

agree
25.0043420

Repair esophagus opening
11.57
14.10
14.35

agree
14.3543425

Repair esophagus opening
16.95
26.93
21.03

agree
21.0343500

Surgical opening of stomach
8.44
11.81
11.05

agree
11.0543501

Surgical repair of stomach
15.31
20.44
20.04

agree
20.0443502

Surgical repair of stomach
17.67
21.20
23.13

agree
23.1343510

Surgical opening of stomach
9.99
18.81
13.08

agree
13.0843520

Incision of pyloric muscle
7.63
8.88
9.99

agree
9.9943605

Biopsy of stomach
9.15
10.41
11.98

agree
11.9843610

Excision of stomach lesion
11.15
17.37
14.60

agree
14.6043611

Excision of stomach lesion
13.63
23.82
17.84

agree
17.8443620

Removal of stomach
22.54
33.61
30.04

agree
30.0443621

Removal of stomach
23.06
35.55
30.73

agree
30.73( print page 31038)43622

Removal of stomach
24.41
35.56
32.53

agree
32.5343631

Removal of stomach, partial
19.66
23.28
22.59

agree
22.5943632

Removal of stomach, partial
19.66
25.92
22.59

agree
22.5943633

Removal of stomach, partial
20.10
27.68
23.10

agree
23.1043634

Removal of stomach, partial
21.86
34.19
25.12

agree
25.1243638

Removal of stomach, partial
21.76
29.96
29.00

agree
29.0043638

Removal of stomach, partial
21.76
39.80
29.00

agree
29.0043639

Removal of stomach, partial
22.25
39.80
29.65

agree
29.6543640

Vagotomy & pylorus repair
14.81
17.32
17.02

agree
17.0243641

Vagotomy & pylorus repair
15.03
21.34
17.27

agree
17.2743651

Laparoscopy, vagus nerve
10.15
15.17
10.15

agree
10.1543652

Laparoscopy, vagus nerve
12.15
19.21
12.15

agree
12.1543800

Reconstruction of pylorus
10.46
11.86
13.69

agree
13.6943810

Fusion of stomach and bowel
11.19
13.81
14.65

agree
14.6543820

Fusion of stomach and bowel
11.74
15.78
15.37

agree
15.3743825

Fusion of stomach and bowel
14.68
18.16
19.22

agree
19.2243830

Place gastrostomy tube
7.28
7.28
9.53

agree
9.5343832

Place gastrostomy tube
11.92
11.92
15.60

agree
15.6043840

Repair of stomach lesion
11.89
11.89
15.56

agree
15.5643842

Gastroplasty for obesity
14.71
17.14
18.47

agree
18.4743843

Gastroplasty for obesity
14.85
20.62
18.65

agree
18.6543846

Gastric bypass for obesity
19.15
23.43
24.05

agree
24.0543847

Gastric bypass for obesity
21.44
29.95
26.92

agree
26.9243848

Revision gastroplasty
23.41
27.07
29.39

agree
29.3943850

Revise stomach-bowel fusion
19.69
23.27
24.72

agree
24.7243855

Revise stomach-bowel fusion
20.83
24.15
26.16

agree
26.1643860

Revise stomach-bowel fusion
19.91
26.08
25.00

agree
25.0043865

Revise stomach-bowel fusion
21.12
27.30
26.52

agree
26.5243870

Repair stomach opening
7.40
9.65
9.69

agree
9.6943880

Repair stomach-bowel fistula
19.63
23.60
24.65

agree
24.6544005

Freeing of bowel adhesion
13.84
15.43
16.23

agree
16.2344010

Incision of small bowel
10.68
15.90
12.52

agree
12.5244020

Exploration of small bowel
11.93
15.04
13.99

agree
13.9944021

Decompress small bowel
12.01
15.18
14.08

agree
14.0844025

Incision of large bowel
12.18
14.08
14.28

agree
14.2844050

Reduce bowel obstruction
11.40
13.75
14.03

agree
14.0344050

Reduce bowel obstruction
11.40
14.58
14.03

agree
14.0344055

Correct malrotation of bowel
13.14
22.00
22.00

agree
22.0044110

Excision of bowel lesion(s)
10.07
14.39
11.81

agree
11.8144111

Excision of bowel lesion(s)
12.19
16.32
14.29

agree
14.2944120

Removal of small intestine
14.50
15.82
17.00

agree
17.0044125

Removal of small intestine
14.96
17.54
17.54

agree
17.5444130

Bowel to bowel fusion
12.36
17.87
14.49

agree
14.4944130

Bowel to bowel fusion
12.36
N/A
14.49

agree
14.4944140

Partial removal of colon
18.35
20.94
18.35

increase
21.0044140

Partial removal of colon
18.35
24.58
18.35

increase
21.0044143

Partial removal of colon
20.17
30.36
20.17

increase
22.9944144

Partial removal of colon
18.89
29.46
18.89

increase
21.5344144

Partial removal of colon
18.89
N/A
18.89

increase
21.5344145

Partial removal of colon
23.18
27.91
23.18

increase
26.4244146

Partial removal of colon
24.16
30.97
24.16

increase
27.5444147

Partial removal of colon
18.17
N/A
18.17

increase
20.7144150

Removal of colon
21.01
27.41
21.01

increase
23.9544151

Removal of colon/ileostomy
20.04
32.89
20.04

increase
26.8844151

Removal of colon/ileostomy
20.04
N/A
20.04

increase
26.8844152

Removal of colon/ileostomy
24.41
33.61
24.41

increase
27.8344153

Removal of colon/ileostomy
26.83
33.11
26.83

increase
30.5944155

Removal of colon/ileostomy
24.44
33.61
24.44

increase
27.8644156

Removal of colon/ileostomy
23.01
36.27
23.01

increase
30.7944156

Removal of colon/ileostomy
23.01
N/A
23.01

increase
30.7944160

Removal of colon
15.88
17.45
18.62

agree
18.6244200

Laparoscopy, enterolysis
14.44
16.11
14.44

agree
14.4444300

Open bowel to skin
8.88
13.09
12.11

agree
12.1144310

Ileostomy/jejunostomy
11.70
18.14
15.95

agree
15.9544312

Revision of ileostomy
5.88
6.79
8.02

agree
8.0244314

Revision of ileostomy
11.04
14.45
15.05

agree
15.05( print page 31039)44316

Devise bowel pouch
15.47
26.57
21.09

agree
21.0944320

Colostomy
12.94
18.84
17.64

agree
17.6444340

Revision of colostomy
5.66
6.79
7.72

agree
7.7244345

Revision of colostomy
11.32
14.45
15.43

agree
15.4344346

Revision of colostomy
12.46
17.19
16.99

agree
16.9944388

Colon endoscopy
2.82
3.10
3.70

decrease
2.8244389

Colonoscopy with biopsy
3.13
3.44
4.26

decrease
3.1344390

Colonoscopy for foreign body
3.83
4.21
4.81

decrease
3.8344391

Colonoscopy for bleeding
4.32
4.75
5.18

decrease
4.3244392

Colonoscopy and polypectomy
3.82
4.20
4.81

decrease
3.8244393

Colonoscopy, lesion removal
4.84
5.32
5.00

decrease
4.8444394

Colonoscopy w/snare
4.43
4.87
4.43

agree
4.4344394

Colonoscopy w/snare
4.43
N/A
4.43

agree
4.4344602

Suture, small intestine
10.61
15.26
11.91

increase
16.0344603

Suture, small intestine
14.00
19.50
15.72

increase
18.6644604

Suture, large intestine
14.28
16.59
16.03

agree
16.0344605

Repair of bowel lesion
15.37
25.03
17.25

increase
19.5344615

Intestinal stricturoplasty
14.19
18.97
15.93

agree
15.9344620

Repair bowel opening
10.87
14.99
12.20

agree
12.2044625

Repair bowel opening
13.41
16.79
15.05

agree
15.0544626

Repair bowel opening
22.59
24.43
25.36

agree
25.3644640

Repair bowel-skin fistula
14.83
22.29
16.65

increase
21.6544650

Repair bowel fistula
15.25
22.29
17.12

increase
22.2744660

Repair bowel-bladder fistula
14.63
24.70
16.42

increase
21.3644661

Repair bowel-bladder fistula
16.99
25.63
19.07

increase
24.8144680

Surgical revision, intestine
13.72
21.32
15.40

agree
15.4044700

Suspend bowel w/prosthesis
14.35
19.35
16.11

agree
16.1144800

Excision of bowel pouch
11.23
10.85
11.23

agree
11.2344820

Excision of mesentery lesion
10.31
11.23
12.09

agree
12.0944850

Repair of mesentery
9.57
12.00
10.74

agree
10.7444900

Drain app abscess, open
8.82
11.79
10.14

agree
10.1444950

Appendectomy
8.70
8.37
10.00

agree
10.0044960

Appendectomy
10.74
13.67
12.34

agree
12.3444970

Laparoscopy, appendectomy
8.70
10.26
8.70

agree
8.7045000

Drainage of pelvic abscess
4.52
10.29
3.88

increase
4.5245020

Drainage of rectal abscess
4.72
7.71
4.05

increase
4.7245100

Biopsy of rectum
3.68
4.34
3.16

increase
3.6845108

Removal of anorectal lesion
4.76
5.25
4.09

increase
4.7645110

Removal of rectum
23.80
29.53
28.00

agree
28.0045111

Partial removal of rectum
16.48
N/A
16.48

agree
16.4845112

Removal of rectum
25.96
32.46
30.54

agree
30.5445113

Partial proctectomy
25.99
33.11
30.58

agree
30.5845114

Partial removal of rectum
23.22
29.46
27.32

agree
27.3245116

Partial removal of rectum
20.89
21.98
24.58

agree
24.5845119

Remove rectum w/reservoir
26.21
31.60
30.84

agree
30.8445120

Removal of rectum
24.60
31.09
24.60

agree
24.6045121

Removal of rectum and colon
27.04
32.14
27.04

agree
27.0445123

Partial proctectomy
14.20
22.51
16.71

agree
16.7145126

Pelvic exenteration
38.39
47.99
45.16

agree
45.1645130

Excision of rectal prolapse
13.97
14.26
16.44

agree
16.4445135

Excision of rectal prolapse
16.39
30.14
19.28

agree
19.2845160

Excision of rectal lesion
13.02
19.86
15.32

agree
15.3245170

Excision of rectal lesion
9.77
12.81
11.49

agree
11.4945190

Destruction, rectal tumor
8.28
9.09
9.74

agree
9.7445305

Proctosigmoidoscopy & biopsy
1.01
1.22
1.01

agree
1.0145309

Proctosigmoidoscopy
2.01
2.45
2.01

agree
2.0145330

Diagnostic sigmoidoscopy
0.96
1.39
0.96

agree
0.9645337

Sigmoidoscopy & decompress
2.36
N/A
2.36

agree
2.3645339

Sigmoidoscopy
3.14
N/A
3.14

agree
3.1445378

Diagnostic colonoscopy
3.70
4.66
3.70

agree
3.7045380

Colonoscopy and biopsy
4.01
5.01
4.44

decrease
4.0145383

Lesion removal colonoscopy
5.87
7.34
5.87

agree
5.8745384

Colonoscopy
4.70
5.88
4.70

agree
4.7045385

Lesion removal colonoscopy
5.31
6.64
5.31

agree
5.3145505

Repair of rectum
6.02
7.57
7.58

agree
7.5845540

Correct rectal prolapse
12.92
17.79
16.27

agree
16.27( print page 31040)45541

Correct rectal prolapse
10.64
13.23
13.40

agree
13.4045550

Repair rectum/remove sigmoid
18.26
27.91
23.00

agree
23.0045560

Repair of rectocele
8.40
7.70
10.58

agree
10.5845562

Exploration/repair of rectum
12.21
12.09
15.38

agree
15.3845563

Exploration/repair of rectum
18.63
21.50
23.47

agree
23.4745800

Repair rect/bladder fistula
14.11
14.36
17.77

agree
17.7745805

Repair fistula w/colostomy
16.50
20.94
20.78

agree
20.7845820

Repair rectourethral fistula
14.67
13.81
18.48

agree
18.4845825

Repair fistula w/colostomy
16.87
20.38
21.25

agree
21.2545900

Reduction of rectal prolapse
1.83
3.27
2.61

agree
2.6145905

Dilation of anal sphincter
1.61
3.15
2.30

agree
2.3045910

Dilation of rectal narrowing
1.96
3.23
2.80

agree
2.8045910

Dilation of rectal narrowing
1.96
N/A
2.80

agree
2.8045915

Remove rectal obstruction
2.20
3.58
3.14

agree
3.1446040

Incision of rectal abscess
4.96
5.53
4.26

increase
4.9646045

Incision of rectal abscess
4.32
5.38
3.71

increase
4.3246060

Incision of rectal abscess
5.69
8.55
4.89

increase
5.6946083

Incise external hemorrhoid
1.40
1.52
1.40

agree
1.4046083

Incise external hemorrhoid
1.40
2.34
1.40

agree
1.4046221

Ligation of hemorrhoid(s)
1.43
1.94
2.04

agree
2.0446230

Removal of anal tabs
2.57
1.94
2.57

agree
2.5746250

Hemorrhoidectomy
4.53
4.13
3.89

agree
3.8946255

Hemorrhoidectomy
5.36
4.98
4.60

agree
4.6046257

Remove hemorrhoids & fissure
6.28
5.43
5.40

agree
5.4046258

Remove hemorrhoids & fistula
6.67
5.86
5.73

agree
5.7346258

Remove hemorrhoids & fistula
6.67
N/A
5.73

agree
5.7346260

Hemorrhoidectomy
7.42
6.18
6.37

agree
6.3746261

Remove hemorrhoids & fissure
8.24
7.11
7.08

agree
7.0846262

Remove hemorrhoids & fistula
8.73
7.11
7.50

agree
7.5046270

Removal of anal fistula
3.72
4.28
3.20

increase
3.7246275

Removal of anal fistula
4.56
5.18
3.92

increase
4.5646280

Removal of anal fistula
5.98
5.95
5.14

increase
5.9846288

Repair anal fistula
7.13
8.08
6.13

increase
7.1346320

Removal of hemorrhoid clot
1.61
1.52
1.61

agree
1.6146320

Removal of hemorrhoid clot
1.61
2.63
1.61

agree
1.6146700

Repair of anal stricture
7.25
10.22
9.13

agree
9.1346705

Repair of anal stricture
7.17
6.90
6.90

agree
6.9046715

Repair of anovaginal fistula
7.46
7.20
7.20

agree
7.2046716

Repair of anovaginal fistula
12.15
15.15
15.07

agree
15.0746730

Construction of absent anus
21.57
25.50
26.75

agree
26.7546735

Construction of absent anus
25.94
36.00
32.17

agree
32.1746740

Construction of absent anus
23.11
35.00
30.00

agree
30.0046742

Repair of imperforated anus
29.67
38.00
35.80

agree
35.8046744

Repair of cloacal anomaly
33.21
52.00
52.63

agree
52.6346746

Repair of cloacal anomaly
36.74
53.50
58.22

agree
58.2246748

Repair of cloacal anomaly
40.52
55.00
64.21

agree
64.2146750

Repair of anal sphincter
8.14
10.99
10.25

agree
10.2546753

Reconstruction of anus
6.58
5.45
8.29

agree
8.2946754

Removal of suture from anus
1.54
2.93
2.20

agree
2.2046760

Repair of anal sphincter
11.46
21.77
14.43

agree
14.4346761

Repair of anal sphincter
10.99
12.15
13.84

agree
13.8446762

Implant artificial sphincter
10.09
15.01
12.71

agree
12.7146900

Destruction, anal lesion(s)
1.91
1.32
1.91

agree
1.9146910

Destruction, anal lesion(s)
1.86
1.72
1.86

agree
1.8646916

Cryosurgery, anal lesion(s)
1.86
1.72
1.86

agree
1.8646917

Laser surgery, anal lesions
1.86
3.32
1.86

agree
1.8646922

Excision of anal lesion(s)
1.86
3.12
1.86

agree
1.8646924

Destruction, anal lesion(s)
2.76
3.93
2.76

agree
2.7646924

Destruction, anal lesion(s)
2.76
4.24
2.76

agree
2.7646934

Destruction of hemorrhoids
4.08
4.63
3.51

agree
3.5146935

Destruction of hemorrhoids
2.43
4.17
2.43

agree
2.4346936

Destruction of hemorrhoids
4.30
5.12
3.69

agree
3.6946940

Treatment of anal fissure
2.32
1.71
2.32

agree
2.3246942

Treatment of anal fissure
2.04
1.71
2.04

agree
2.0446945

Ligation of hemorrhoids
2.14
2.37
1.84

agree
1.8446946

Ligation of hemorrhoids
3.00
2.57
2.58

agree
2.58( print page 31041)47010

Open drainage, liver lesion
10.28
16.25
16.01

agree
16.0147015

Inject/aspirate liver cyst
9.70
19.15
15.11

agree
15.1147100

Wedge biopsy of liver
7.49
9.24
11.67

agree
11.6747120

Partial removal of liver
22.79
39.57
35.50

agree
35.5047122

Extensive removal of liver
35.39
53.02
55.13

agree
55.1347125

Partial removal of liver
31.58
44.50
49.19

agree
49.1947130

Partial removal of liver
34.25
46.45
53.35

agree
53.3547134

Partial removal, donor liver
39.15
49.00
CPT

CPT
39.1547300

Surgery for liver lesion
9.68
12.45
15.08

agree
15.0847350

Repair liver wound
12.56
19.16
19.56

agree
19.5647360

Repair liver wound
17.28
28.64
26.92

agree
26.9247361

Repair liver wound
30.25
40.14
47.12

agree
47.1247362

Repair liver wound
11.88
24.94
18.51

agree
18.5147400

Incision of liver duct
20.86
35.12
32.49

agree
32.4947420

Incision of bile duct
16.72
27.63
19.88

agree
19.8847425

Incision of bile duct
16.68
32.49
19.83

agree
19.8347460

Incise bile duct sphincter
15.17
25.74
18.04

agree
18.0447480

Incision of gallbladder
9.10
15.26
10.82

agree
10.8247562

Laparoscopic cholecystectomy
11.09
9.59
11.09

agree
11.0947563

Laparoscopic cholecystectomy
11.94
12.40
11.94

agree
11.9447564

Laparo cholecystectomy/explr
14.23
17.67
14.23

agree
14.2347570

Laparo cholecystoenterostomy
12.58
18.62
12.58

agree
12.5847600

Removal of gallbladder
11.42
11.67
13.58

agree
13.5847605

Removal of gallbladder
12.36
13.26
14.69

agree
14.6947610

Removal of gallbladder
15.83
17.97
18.82

agree
18.8247612

Removal of gallbladder
15.80
22.68
18.78

agree
18.7847620

Removal of gallbladder
17.36
24.70
20.64

agree
20.6447701

Bile duct revision
27.81
36.50
27.81

agree
27.8147711

Excision of bile duct tumor
19.37
31.38
23.03

agree
23.0347712

Excision of bile duct tumor
25.44
38.58
30.24

agree
30.2447715

Excision of bile duct cyst
15.81
32.81
18.80

agree
18.8047716

Fusion of bile duct cyst
13.83
19.34
16.44

agree
16.4447720

Fuse gallbladder & bowel
13.38
18.16
15.91

agree
15.9147721

Fuse upper gi structures
16.08
21.91
19.12

agree
19.1247740

Fuse gallbladder & bowel
15.54
20.63
18.48

agree
18.4847741

Fuse gallbladder & bowel
17.95
24.39
21.34

agree
21.3447760

Fuse bile ducts and bowel
21.74
21.91
25.85

agree
25.8547765

Fuse liver ducts & bowel
20.93
30.62
24.88

agree
24.8847780

Fuse bile ducts and bowel
22.29
26.86
26.50

agree
26.5047785

Fuse bile ducts and bowel
26.23
36.32
31.18

agree
31.1847800

Reconstruction of bile ducts
19.60
26.89
23.30

agree
23.3047801

Placement, bile duct support
12.76
23.47
15.17

agree
15.1747802

Fuse liver duct & intestine
18.13
34.11
21.55

agree
21.5547900

Suture bile duct injury
16.74
20.50
19.90

agree
19.9048000

Drainage of abdomen
14.91
40.79
28.07

agree
28.0748001

Placement of drain, pancreas
18.83
55.20
35.45

agree
35.4548005

Resect/debride pancreas
22.40
57.70
42.17

agree
42.1748020

Removal of pancreatic stone
14.22
23.50
15.70

agree
15.7048100

Biopsy of pancreas
11.08
14.57
12.23

agree
12.2348120

Removal of pancreas lesion
14.36
26.05
15.85

agree
15.8548140

Partial removal of pancreas
20.78
28.60
22.94

agree
22.9448145

Partial removal of pancreas
21.76
34.32
24.02

agree
24.0248146

Pancreatectomy
23.91
45.57
26.40

agree
26.4048148

Removal of pancreatic duct
15.71
25.00
17.34

agree
17.3448150

Partial removal of pancreas
43.48
54.73
48.00

agree
48.0048150

Partial removal of pancreas
43.48
54.75
48.00

agree
48.0048152

Pancreatectomy
39.63
39.63
43.75

agree
43.7548153

Pancreatectomy
43.38
54.73
47.89

agree
47.8948154

Pancreatectomy
39.95
51.80
44.10

agree
44.1048155

Removal of pancreas
22.32
44.70
24.64

agree
24.6448180

Fuse pancreas and bowel
22.39
32.52
24.72

agree
24.7248500

Surgery of pancreas cyst
13.84
18.99
15.28

agree
15.2848510

Drain pancreatic pseudocyst
12.96
16.08
14.31

agree
14.3148520

Fuse pancreas cyst and bowel
14.12
19.68
15.59

agree
15.5948540

Fuse pancreas cyst and bowel
17.86
21.28
19.72

agree
19.7248545

Pancreatorrhaphy
16.47
33.39
18.18

agree
18.18( print page 31042)48547

Duodenal exclusion
23.40
41.76
25.83

agree
25.8349000

Exploration of abdomen
11.68
13.42
11.68

agree
11.6849002

Reopening of abdomen
10.49
12.67
10.49

agree
10.4949010

Exploration behind abdomen
12.28
15.06
12.28

agree
12.2849020

Drain abdominal abscess
16.79
28.33
20.73

increase
22.8449040

Drain, open, abdom abscess
9.94
23.60
12.27

increase
13.5249060

Drain, open, retrop abscess
11.66
19.52
14.40

increase
15.8649085

Remove abdomen foreign body
8.93
14.23
11.03

increase
12.1449200

Removal of abdominal lesion
10.25
12.19
10.25

agree
10.2549201

Removal of abdominal lesion
14.84
16.27
14.84

agree
14.8449215

Excise sacral spine tumor
22.36
24.96
33.50

agree
33.5049215

Excise sacral spine tumor
22.36
30.00
33.50

agree
33.5049220

Multiple surgery, abdomen
14.88
17.39
14.88

agree
14.8849255

Removal of omentum
11.14
13.42
11.14

agree
11.1449320

Diag laparo separate proc
5.10
5.95
5.10

agree
5.1049321

Laparoscopy; biopsy
5.40
N/A
5.40

agree
5.4049322

Laparoscopy; aspiration
5.70
N/A
5.70

agree
5.7049421

Insert abdominal drain
5.54
6.99
5.54

agree
5.5449422

Remove perm cannula/catheter
6.25
6.35
6.25

agree
6.2549425

Insert abdomen-venous drain
11.37
13.82
11.37

agree
11.3749426

Revise abdomen-venous shunt
9.63
11.10
9.63

agree
9.6349428

Ligation of shunt
2.38
5.38
6.06

agree
6.0649429

Removal of shunt
7.40
9.57
7.40

agree
7.4049495

Repair inguinal hernia, init
5.89
6.96
CPT

CPT
5.8949495

Repair inguinal hernia, init
5.89
12.50
CPT

CPT
5.8949496

Repair inguinal hernia, init
8.79
10.56
CPT

CPT
8.7949496

Repair inguinal hernia, init
8.79
14.00
CPT

CPT
8.7949500

Repair inguinal hernia
4.68
7.61
5.48

agree
5.4849501

Repair inguinal hernia, init
7.58
9.26
8.88

agree
8.8849505

Repair inguinal hernia
6.49
8.31
7.60

agree
7.6049505

Repair inguinal hernia
6.49
11.50
7.60

agree
7.6049507

Repair inguinal hernia
8.17
11.38
9.57

agree
9.5749520

Rerepair inguinal hernia
8.22
11.02
9.63

agree
9.6349521

Repair inguinal hernia, rec
10.22
13.97
11.97

agree
11.9749525

Repair inguinal hernia
7.32
8.36
8.57

agree
8.5749540

Repair lumbar hernia
8.87
8.52
10.39

agree
10.3949550

Repair femoral hernia
7.37
8.36
8.63

agree
8.6349553

Repair femoral hernia, init
8.06
10.31
9.44

agree
9.4449555

Repair femoral hernia
7.71
8.50
9.03

agree
9.0349557

Repair femoral hernia, recur
9.52
11.82
11.15

agree
11.1549560

Repair abdominal hernia
9.88
11.69
11.57

agree
11.5749561

Repair incisional hernia
12.17
15.67
14.25

agree
14.2549565

Rerepair abdominal hernia
9.88
14.03
11.57

agree
11.5749566

Repair incisional hernia
12.30
16.43
14.40

agree
14.4049570

Repair epigastric hernia
4.86
7.00
5.69

agree
5.6949572

Repair epigastric hernia
5.75
9.77
6.73

agree
6.7349580

Repair umbilical hernia
3.51
5.71
4.11

agree
4.1149582

Repair umbilical hernia
5.68
9.99
6.65

agree
6.6549585

Repair umbilical hernia
5.32
5.71
6.23

agree
6.2349587

Repair umbilical hernia
6.46
9.34
7.56

agree
7.5649590

Repair abdominal hernia
7.29
9.54
8.54

agree
8.5449605

Repair umbilical lesion
22.66
97.62
76.00

decrease
22.6649606

Repair umbilical lesion
18.60
21.31
18.60

agree
18.6049650

Laparo hernia repair initial
6.27
7.66
6.27

agree
6.2749651

Laparo hernia repair recur
8.24
7.88
8.24

agree
8.2449900

Repair of abdominal wall
12.28
16.92
12.28

agree
12.2849905

Omental flap
6.55
17.79
CPT

CPT
6.5550200

Biopsy of kidney
2.63
N/A
CPT

CPT
2.6350230

Removal of kidney
22.07
N/A
CPT

CPT
22.0751595

Remove bladder/revise tract
37.14
N/A
37.14

agree
37.1451596

Remove bladder/create pouch
39.52
N/A
39.52

agree
39.5252300

Cystoscopy and treatment
5.31
WD
(e)

(a)
5.3152327

Cystoscopy, inject material
5.19
WD
(e)

(a)
5.1952340

Cystoscopy and treatment
9.68
WD
(e)

(a)
9.6856515

Destruction, vulva lesion(s)
1.88
3.09
2.76

agree
2.7656740

Remove vagina gland lesion
3.76
5.74
4.57

agree
4.57( print page 31043)57100

Biopsy of vagina
0.97
1.90
1.20

agree
1.2057130

Remove vagina lesion
2.43
5.67
2.43

agree
2.4357292

Construct vagina with graft
13.09
N/A
13.09

agree
13.0957307

Fistula repair & colostomy
15.93
20.24
15.93

agree
15.9357410

Pelvic examination
1.75
4.08
1.75

agree
1.7557505

Endocervical curettage
1.14
0.97
1.14

agree
1.1457555

Remove cervix/repair vagina
8.95
WD
(e)

(a)
8.9558150

Total hysterectomy
15.24
17.75
15.24

agree
15.2458152

Total hysterectomy
15.09
20.60
20.60

agree
20.6058260

Vaginal hysterectomy
12.20
12.98
12.98

agree
12.9858262

Vaginal hysterectomy
13.99
17.88
14.77

agree
14.7758263

Vaginal hysterectomy
15.28
21.26
16.06

agree
16.0658267

Hysterectomy & vagina repair
15.00
17.55
17.04

agree
17.0458270

Hysterectomy & vagina repair
13.48
15.58
14.26

agree
14.2658275

Hysterectomy/revise vagina
14.98
N/A
15.76

agree
15.7658280

Hysterectomy/revise vagina
15.41
N/A
17.01

agree
17.0158285

Extensive hysterectomy
18.57
N/A
22.26

agree
22.2658323

Sperm washing
0.23
0.55
0.23

agree
0.2358400

Suspension of uterus
6.36
11.68
6.36

agree
6.3658600

Division of fallopian tube
3.84
4.60
5.60

agree
5.6058605

Division of fallopian tube
3.34
4.60
5.00

agree
5.0058611

Ligate oviduct(s) add-on
0.63
N/A
1.45

agree
1.4558700

Removal of fallopian tube
6.49
11.68
12.05

agree
12.0558740

Revise fallopian tube(s)
5.83
11.29
14.00

agree
14.0058805

Drainage of ovarian cyst(s)
5.88
11.68
5.88

agree
5.8858820

Drain ovary abscess, open
4.22
6.03
4.22

agree
4.2258825

Transposition, ovary(s)
6.13
11.68
10.98

agree
10.9858920

Partial removal of ovary(s)
6.78
11.68
11.36

agree
11.3658950

Resect ovarian malignancy
15.27
16.93
16.93

agree
16.9358951

Resect ovarian malignancy
21.81
28.99
22.38

agree
22.3859150

Treat ectopic pregnancy
6.89
11.67
11.67

agree
11.6759151

Treat ectopic pregnancy
7.86
11.49
11.49

agree
11.4959812

Treatment of miscarriage
3.25
4.01
4.01

agree
4.0159870

Evacuate mole of uterus
4.28
5.00
6.01

agree
6.0160100

Biopsy of thyroid
0.97
1.88
1.56

agree
1.5660220

Partial removal of thyroid
10.53
11.82
11.90

agree
11.9060220

Partial removal of thyroid
10.53
14.24
11.90

agree
11.9060252

Removal of thyroid
18.20
22.32
20.57

agree
20.5760254

Extensive thyroid surgery
23.88
27.43
26.99

agree
26.9960260

Repeat thyroid surgery
15.46
18.83
17.47

agree
17.4760270

Removal of thyroid
17.94
23.05
20.27

agree
20.2760271

Removal of thyroid
14.89
18.68
16.83

agree
16.8360280

Remove thyroid duct lesion
6.08
WD
(e)

(a)
6.0860540

Explore adrenal gland
17.03
20.53
17.03

agree
17.0360545

Explore adrenal gland
19.88
25.66
19.88

agree
19.8862263

Lysis epidural adhesions
6.14
7.20
7.20

(b)
6.1462310

Inject spine c/t
1.91
1.95
2.20

(b)
1.9162311

Inject spine l/s (cd)
1.54
1.57
1.78

(b)
1.5462318

Inject spine w/cath, c/t
2.04
2.26
2.35

(b)
2.0462319

Inject spine w/cath l/s (cd)
1.87
1.88
2.15

(b)
1.8765855

Laser surgery of eye
4.30
N/A
3.85

agree
3.8566170

Glaucoma surgery
12.16
WD
(e)

(a)
12.1666172

Incision of eye
15.04
WD
(e)

(a)
15.0466180

Implant eye shunt
14.55
N/A
14.55

agree
14.5566986

Exchange lens prosthesis
12.28
N/A
12.28

agree
12.2867028

Injection eye drug
2.52
N/A
2.52

agree
2.5267108

Repair detached retina
20.82
WD
(e)

(a)
20.8267218

Treatment of retinal lesion
13.52
N/A
18.53

agree
18.5367904

Repair eyelid defect
6.26
N/A
6.26

agree
6.2669000

Drain external ear lesion
1.45
WD
(e)

(a)
1.4569005

Drain external ear lesion
2.11
WD
(e)

(a)
2.1169020

Drain outer ear canal lesion
1.48
WD
(e)

(a)
1.4869100

Biopsy of external ear
0.81
WD
(e)

(a)
0.8169105

Biopsy of external ear canal
0.85
WD
(e)

(a)
0.8569110

Remove external ear, partial
3.44
WD
(e)

(a)
3.4469120

Removal of external ear
4.05
WD
(e)

(a)
4.05( print page 31044)69140

Remove ear canal lesion(s)
7.97
WD
(e)

(a)
7.9769145

Remove ear canal lesion(s)
2.62
WD
(e)

(a)
2.6269150

Extensive ear canal surgery
13.43
WD
(e)

(a)
13.4369155

Extensive ear/neck surgery
20.80
WD
(e)

(a)
20.8069200

Clear outer ear canal
0.77
WD
(e)

(a)
0.7769205

Clear outer ear canal
1.20
WD
(e)

(a)
1.2069210

Remove impacted ear wax
0.61
WD
(e)

(a)
0.6169220

Clean out mastoid cavity
0.83
WD
(e)

(a)
0.8369222

Clean out mastoid cavity
1.40
WD
(e)

(a)
1.4069300

Revise external ear
6.36
WD
(e)

(a)
6.3669310

Rebuild outer ear canal
10.79
WD
(e)

(a)
10.7969320

Rebuild outer ear canal
16.96
WD
(e)

(a)
16.9669400

Inflate middle ear canal
0.83
WD
(e)

(a)
0.8369401

Inflate middle ear canal
0.63
WD
(e)

(a)
0.6369405

Catheterize middle ear canal
2.63
WD
(e)

(a)
2.6369410

Inset middle ear (baffle)
0.33
WD
(e)

(a)
0.3369420

Incision of eardrum
1.33
WD
(e)

(a)
1.3369421

Incision of eardrum
1.73
WD
(e)

(a)
1.7369424

Remove ventilating tube
0.85
WD
(e)

(a)
0.8569433

Create eardrum opening
1.52
WD
(e)

(a)
1.5269436

Create eardrum opening
1.96
WD
(e)

(a)
1.9669440

Exploration of middle ear
7.57
WD
(e)

(a)
7.5769450

Eardrum revision
5.57
WD
(e)

(a)
5.5769501

Mastoidectomy
9.07
WD
(e)

(a)
9.0769502

Mastoidectomy
12.38
WD
(e)

(a)
12.3869505

Remove mastoid structures
12.99
WD
(e)

(a)
12.9969511

Extensive mastoid surgery
13.52
WD
(e)

(a)
13.5269530

Extensive mastoid surgery
19.19
WD
(e)

(a)
19.1969535

Remove part of temporal bone
36.14
WD
(e)

(a)
36.1469540

Remove ear lesion
1.20
WD
(e)

(a)
1.2069550

Remove ear lesion
10.99
WD
(e)

(a)
10.9969552

Remove ear lesion
19.46
WD
(e)

(a)
19.4669554

Remove ear lesion
33.16
WD
(e)

(a)
33.1669601

Mastoid surgery revision
13.24
WD
(e)

(a)
13.2469602

Mastoid surgery revision
13.58
WD
(e)

(a)
13.5869603

Mastoid surgery revision
14.02
WD
(e)

(a)
14.0269604

Mastoid surgery revision
14.02
WD
(e)

(a)
14.0269605

Remove mastoid structures
18.49
WD
(e)

(a)
18.4969610

Repair of eardrum
4.43
WD
(e)

(a)
4.4369620

Repair of eardrum
5.89
WD
(e)

(a)
5.8969631

Rebuild eardrum structures
9.86
WD
(e)

(a)
9.8669632

Rebuild eardrum structures
12.75
WD
(e)

(a)
12.7569633

Rebuild eardrum structures
12.10
WD
(e)

(a)
12.1069635

Repair eardrum structures
13.33
WD
(e)

(a)
13.3369636

Rebuild eardrum structures
15.22
WD
(e)

(a)
15.2269637

Rebuild eardrum structures
15.11
WD
(e)

(a)
15.1169641

Revise middle ear & mastoid
12.71
WD
(e)

(a)
12.7169642

Revise middle ear & mastoid
16.84
WD
(e)

(a)
16.8469643

Revise middle ear & mastoid
15.32
WD
(e)

(a)
15.3269644

Revise middle ear & mastoid
16.97
WD
(e)

(a)
16.9769645

Revise middle ear & mastoid
16.38
WD
(e)

(a)
16.3869646

Revise middle ear & mastoid
17.99
WD
(e)

(a)
17.9969650

Release middle ear bone
9.66
WD
(e)

(a)
9.6669660

Revise middle ear bone
11.90
WD
(e)

(a)
11.9069661

Revise middle ear bone
15.74
WD
(e)

(a)
15.7469662

Revise middle ear bone
15.44
WD
(e)

(a)
15.4469666

Repair middle ear structures
9.75
WD
(e)

(a)
9.7569667

Repair middle ear structures
9.76
WD
(e)

(a)
9.7669670

Remove mastoid air cells
11.51
WD
(e)

(a)
11.5169676

Remove middle ear nerve
9.52
WD
(e)

(a)
9.5269700

Close mastoid fistula
8.23
WD
(e)

(a)
8.2369711

Remove/repair hearing aid
10.44
WD
(e)

(a)
10.4469720

Release facial nerve
14.38
WD
(e)

(a)
14.3869725

Release facial nerve
25.38
WD
(e)

(a)
25.3869740

Repair facial nerve
15.96
WD
(e)

(a)
15.9669745

Repair facial nerve
16.69
WD
(e)

(a)
16.69( print page 31045)69801

Incise inner ear
8.56
WD
(e)

(a)
8.5669802

Incise inner ear
13.10
WD
(e)

(a)
13.1069805

Explore inner ear
13.82
WD
(e)

(a)
13.8269806

Explore inner ear
12.35
WD
(e)

(a)
12.3569820

Establish inner ear window
10.34
WD
(e)

(a)
10.3469840

Revise inner ear window
10.26
WD
(e)

(a)
10.2669905

Remove inner ear
11.10
WD
(e)

(a)
11.1069910

Remove inner ear & mastoid
13.63
WD
(e)

(a)
13.6369915

Incise inner ear nerve
21.23
WD
(e)

(a)
21.2369930

Implant cochlear device
16.81
WD
(e)

(a)
16.8169950

Incise inner ear nerve
25.64
WD
(e)

(a)
25.6469955

Release facial nerve
27.04
WD
(e)

(a)
27.0469960

Release inner ear canal
27.04
WD
(e)

(a)
27.0469970

Remove inner ear lesion
30.04
WD
(e)

(a)
30.0469990

Microsurgery add-on
3.47
N/A
3.47

agree
3.4772275

Epidurography
0.76
0.83
0.83

(b)
0.7676005

Fluoroguide for spine inject
0.60
0.60
10.60

agree
0.6076065

X-rays, bone evaluation
0.28
0.60
0.70

agree
0.7076090

Mammogram, one breast
0.58
0.64
0.70

agree
0.7076091

Mammogram, both breasts
0.69
0.76
0.87

agree
0.8776095

Stereotactic breast biopsy
1.59
3.58
1.59

agree
1.5988170

Fine needle aspiration
1.27
3.28
1.27

agree
1.2788171

Fine needle aspiration
1.27
2.63
1.27

agree
1.2790901

Biofeedback train, any meth
0.41
N/A

0.41
agree
0.4190911

Biofeedback peri/uro/rectal
0.89
N/A
0.89

agree
0.8990935

Hemodialysis, one evaluation
1.22
N/A
CPT

CPT
1.2290937

Hemodialysis, repeated eval
2.11
N/A
CPT

CPT
2.1190945

Dialysis, one evaluation
1.28
N/A
CPT

CPT
1.2890947

Dialysis, repeated eval
2.16
N/A
CPT

CPT
2.1690989

Dialysis training, complete
0.00
N/A
CPT

CPT
0.0090993

Dialysis training, incompl
0.00
N/A
CPT

CPT
0.0090997

Hemoperfusion
1.84
N/A
CPT

CPT
1.8492018

New eye exam & treatment
1.51
N/A
2.50

agree
2.5093350

Echo transthoracic
0.78
N/A
1.48

agree
1.4894640

Airway inhalation treatment
0.00
N/A
0.00

agree
0.0094664

Aerosol or vapor inhalations
0.00
N/A
CPT

CPT
0.0094665

Aerosol or vapor inhalations
0.00
N/A
CPT

CPT
0.0096100

Psychological testing
0.00
2.00

(a)
agree
0.0096105

Assessment of aphasia
0.00
2.00

(a)
agree
0.0096110

Developmental test, lim
0.00
2.00

(a)
agree
0.0096115

Neurobehavior status exam
0.00
2.20

(a)
agree
0.0096117

Neuropsych test battery
0.00
2.20

(a)
agree
0.0097542

Wheelchair mngmnt training
0.25
0.45

0.45
agree
0.4599233

Subsequent hospital care
1.51
N/A
1.51

agree
1.5199273

Confirmatory consultation
1.19
N/A
1.19

agree
1.1999274

Confirmatory consultation
1.73
N/A
1.73

agree
1.7399291

Critical care, first hour
3.60
4.00
4.00

agree
4.0099291

Critical care, first hour
3.60
5.50
4.00

agree
4.0099291

Critical care, first hour
3.60
N/A
4.00

agree
4.0099292

Critical care, addl 30 min
1.80
2.00
2.00

agree
2.0099292

Critical care, addl 30 min
1.80
2.77
2.00

agree
2.0099292

Critical care, addl 30 min
1.80
N/A
2.00

agree
2.0099295

Neonatal critical care
16.00
N/A
16.00

agree
16.0099296

Neonatal critical care
8.00
N/A
8.00

agree
8.0099297

Neonatal critical care
4.00
N/A
4.00

agree
4.0099298

Neonatal critical care
2.75
N/A
2.75

agree
2.7599436

Attendance, birth
1.50
N/A
1.50

agree
1.5099440

Newborn resuscitation
2.93
N/A
2.93

agree
2.93G0127

Trim nail(s)
0.11
N/A

(a)
(a)
0.11
 
 
    B. Discussion of Comments by Clinical Area 1. Vascular Surgery *Comment:*
                         The Society for Vascular Surgery (SVS) and the North American Chapter of the International Society for Cardiovascular Surgery requested increases in work RVUs for 95 codes. Both groups commented that vascular surgery procedures were undervalued in the original Harvard Study and that only a small number of these RVUs have been adjusted since that time. The SVS's recommendations were based on surveys, a full RUC survey of 39 higher volume codes and minisurveys for 56 less frequently performed codes. (The full and minisurveys included estimates for each code of pre-, intra-, and postservice times and visits as well as estimates of physician work. The effect of these recommendations would be to correct current rank-order anomalies, while avoiding creation of new rank-order anomalies.) The SVS used a building-block approach to validate the survey results for each of their codes. RUC Recommendation Of the 95 codes, the RUC recommended increases for 91 codes, a decrease for 1 code and no changes for 3 codes. In 60 percent of cases, the RUC recommendations to increase the work RVUs were based on physician surveys. The recommendations were based on either the 25th percentile or the median of survey responses. In almost all other cases, the RUC recommendation for a specific code work RVU was based on the work value of another comparable code. The building-block approach was used only to corroborate findings from the surveys or validate a comparison to another procedure. The following are the RUC recommendations for the codes submitted. (Please note that throughout this document the value in parentheses represents the RUC-recommended work RVUs unless they are shown in columns.) CPT codes
Work RVUs**Family 1 Aneurysm Repairs in Abdomen**35111
25.0035131
25.0035112
30.0035132
30.0035121
30.0035122
35.0035082
38.5035103
40.5035092
45.00**Family 2 Bypass Grafts in the Abdomen**35665
21.0035663
22.0035565
23.2035563
24.2035636
29.5035536
31.7035560
32.0035631
34.0035531
36.20**Family 3 Embolectomy/Thrombectomy in the Abdomen**34401
25.0034151
25.0034451
27.00**Family 4 Endarterectomy in the Abdomen**35351
23.0035331
26.2035361
28.2035363
30.20**Family 5 Repair Blood Vessels in the Abdomen**37660
21.0037617
22.0635221
24.3935281
28.0035251
30.20**Family 6 Explorations, Revisions, Other in Chest & Abdomen**35189
28.0035182
30.0035905
31.2535907
35.00( print page 31047)**Family 7 Extra-anatomic Bypass Grafts**35661
19.0035650
19.0035621
20.0035558
21.2035511
21.2035518
21.2035623
24.0035521
22.2035654
25.0035533
28.00**Family 8 Arterial Bypass Grafts in Extremities**35666
22.1935671
19.2335571
24.0635587
24.75**Family 9 Embolectomy/Thrombectomy by Extremity Incision**34490
9.8634111
10.0034201
10.0334101
10.0034421
12.0034203
16.50**Family 10 Aneurysm Repairs in the Extremity**35045
17.5735011
18.0035141
20.0035013
22.0035151
22.6435142
23.3035152
25.62**Family 11 Endarterectomy of Extremity Arteries**35371
14.7235321
16.0035372
18.0035355
18.50**Family 12 Arteriovenous Fistula Repairs in the Extremities**35190
No change in work RVUs35184
18.00**Family 13 Peripheral Artery and Vein Ligations**35721
7.1837650
7.8035741
8.0037618
No change in work RVUs37565
10.8837600
11.2535701
8.5037605
13.1137615
No change in work RVUs**Family 14 Vessel/Repairs in Extremities and Neck**35201
16.1435206
13.2535226
14.5035266
14.9135261
17.8035286
16.1635236
17.1135231
20.0035256
18.36( print page 31048)**Family 15 Reconstruction for Chronic Venous Disease**34501
16.0034520
17.9534510
18.9534530
16.64 (decrease)**Family 16 Repairs, Bypass Grafts, Endarterectomies in the Chest**35276
24.2535246
26.4535626
27.7535526
29.9535311
27.00**Family 17 Ligation or Biopsy of Temporal Artery**37609
3.00**Family 18 Untitled**35081
28.0135556
21.76
 The RUC recommended the following codes be submitted to the CPT Editorial Panel for further consideration: 35381, 35541, 35546, 35551, 35582, 35641, 35646, 35840, 35860, 37615, 37618, 37700, 37730, 37735, 37760, 37785. *HCFA Proposal:* We have reviewed and propose to accept all of the RUC recommendations for the vascular surgery codes. We believe that relativity is maintained, and the RVUs more appropriately reflect the work involved. 2. General Surgery/Colon and Rectal Surgery *Comment:*
                         The American Society of General Surgeons (ASGS) submitted 55 codes it believed to be undervalued. The ASGS recommended work RVUs for each service. After submitting the codes, the specialty society ultimately chose not to pursue review of RVUs for the following codes under the 5-year review: 20605, 34001, and 29881. The following codes 49505, 32440, 46320, 46924, 31622, 44140 (no change), 38500, 32480, 37609, 43239, 43638, 60220, 44050, 48150, and 38100 were also submitted for review by other specialty groups and are discussed in other sections. (Note that codes 56305, 56341, 56300, 56340, and 56306 are laparoscopic surgery codes also submitted for review by the specialty group; however, these services were deleted or renumbered by CPT for 2000.) *RUC Recommendation:* The RUC recommended that the work RVUs for the following codes be increased (the RUC-recommended work RVUs are in parentheses): Code 36489, 
                        *Placement of central venous catheter (subclavian, jugular, or other vein (eg, for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy)); percutaneous, age 2 years or under*
                         (2.50) to correct a rank-order anomaly; 60100, 
                        *Biopsy thyroid, percutaneous core needle*
                         (1.56), to appropriately reflect the work involved and fit in the range of biopsy codes; and 31600, 
                        *Tracheostomy, planned (separate procedure)*
                         (7.18), based on the building-block approach and the comparison to similar procedures. For the following codes, the RUC stated that there was no compelling evidence provided to support increasing the work RVUs. Therefore, it recommended maintaining the current work RVUs for the following codes: 19100, 88170, 57410, 76095, 88171, 32000, 21800, 46083, 19000, 19125, 45330, 19160, 13101, 11402, 12011, 11642, 27590, 45378, 36625, 45309, 45305, 35081, 19240, 58150, 43246, 19162, and 35556. The RUC also recommended maintaining the current work RVUs for codes 49321 and 49322 because these services had recently been reviewed by the RUC. The RUC recommended that the following codes be referred to the CPT Editorial Panel for review or clarification: 37720 and 43215. *HCFA Proposal:* We have reviewed and propose to accept all of the RUC recommendations for these surgery codes. *Comment:* The American College of Surgeons (ACS) submitted general surgery codes for review that account for approximately 50 percent of general surgery's Medicare-allowed charges for services categorized as surgery under our “type of service” classification. The procedures are predominantly performed by general surgeons, and they involve the gastrointestinal tract, abdominal organs, thyroid, lymph system, and endocrine system. Requests for review of some of these codes were also submitted by other specialty groups. In its comments, the ACS emphasized that its analysis determined that the work of codes in general surgery has been systematically undervalued. The ACS used a building-block approach with panel-assigned intraoperative work intensities for procedures. Preoperative work RVUs were determined based on an assigned intensity multiplied by the number of preservice minutes. The assigned preservice work intensity was below that of an evaluation and management service. A panel of ASC members assigned intraservice work intensity to each code using a scale. The intensity of an evaluation and management service was the low end of the scale, and liver resection services were on the high end of the scale. The ends of the scale were chosen to represent “average” work intensity throughout a procedure. The ACS maintains that the work intensity of any surgical procedure is greater than the work intensity of an evaluation and management service. Postservice work RVUs were calculated using current work RVUs for hospital visits and discounted work RVUs for office visits. Pre, intra-, and postwork RVUs were summed to equal the new work RVUs that the ACS developed for each code. 
                        ( print page 31049) The ACS assigned over 300 codes to 31 families of similar services (for example, all codes related to hernia repair were in one family). It conducted a traditional RUC survey for 32 codes (either high volume services or the service most representative of the family of codes). A minisurvey, which did not include a respondent-recommended work value, was conducted for the remaining codes, with participation from other specialty groups. The ACS indicated that the survey respondents tended to overvalue codes at the low end of the scale and undervalue codes at the high end of the scale. As a result, ACS recommended using the 25th percentile of survey results at the low end and the 75th percentile for work RVUs at the high end of the scale for fully-surveyed codes. However, they stated that acceptance of these survey results without adjustments to other codes in the family that were not fully surveyed would distort the relativity within and across families. They recommended a regression methodology to extrapolate the fully-surveyed code results to the other codes. *RUC Recommendation:* The RUC workgroup reviewed the data collected for the 32 fully-surveyed ACS codes. It also reviewed the families of services proposed by ACS and modified the families that were too dissimilar to permit appropriate comparison within the family. After the anchor code was reviewed, each family was reviewed to determine whether the change to the anchor code should be applied to the entire family of codes. In some instances the RUC agreed that the recommended change in the anchor code should be extrapolated to the entire family to ensure that rank-order and relativity distortions were not created by a change to the anchor code. In other instances the RUC determined that the recommendation for the anchor code did not apply to the family of codes. In these instances, either new RVUs were recommended or the present work RVUs were maintained. The following are the code-specific RUC recommendations: CPT codes
Work RVUs**Family 1A & B Thyroid/Endocrine**60220
11.9060252
20.5760254
26.9960260
17.4760270
20.2760271
16.8360540
No change60545
No change**Family 2 Lymphadenectomy**38740
8.4238745
11.0038760
10.8838765
19.98**Family 3 Lymph Nodes and Lymphatic Channels—Incision/Excision**38300
1.9938305
6.0038308
6.4538500
3.7538510
6.4338520
6.6738525
6.0738530
7.98**Family 4 Intestines—Excision/Incision**44005
16.2344010
12.5244020
13.9944021
14.0844025
14.2844050
14.0344110
11.8144111
14.2944120
17.0044125
17.5444130
14.4944160
18.6244800
11.2344820
12.09**Family 5 Intestines—External Fistulization**44300
12.1144310
15.9544312
8.0244314
15.0544316
21.09( print page 31050)44320
17.6444340
17.7244345
15.4344346
16.99**Family 6 Intestines—Colectomy**Codes 44140, 44143, 44144, 44145, 44146, 44150, 44151, 44152, 44153, 44155, and 44156. The RUC made no changes to any of these codes based on the lack of compelling evidence.**Family 7 intestines—Repair**44602
11.9144603
15.7244604
16.0344605
17.2544615
15.9344620
12.2044625
15.0544626
25.3644640
16.6544650
17.1244660
16.4244661
19.0744680
15.4044700
16.1144850
10.74**Family 8 Anus/Rectum—Hemorrhoids/Fistula**45000
3.8845020
4.0545100
3.1645108
4.0946040
4.2646045
3.7146060
4.8946250
3.8946255
4.6046257
5.4046258
5.7346260
6.3746261
7.0846262
7.5046270
3.2046275
3.9246280
5.1446288
6.1346934
3.5146936
3.6946945
1.8446946
2.58**Note:**
                                 All of the work RVUs for Family 8 reflect a recommended decrease from the CY 2000 work RVUs.**Family 9 A B &C Anus/Rectum, Anus (destruction)—10-day global**45900
2.6145905
2.3045910
2.8045915
3.1446221
2.0446754
2.20**Note:**
                                 Based on the lack of compelling evidence, the RUC recommended that no changes be made to the following Family 9 codes: 46083, 46230, 46320, 46935, 46940, 46942, 46900, 46910, 46916, 46917, 46922, and 46924.**Family 10 Anus/Rectum Repair**45505
7.5845540
16.2745541
13.4045550
23.0045560
10.5845562
15.3845563
23.47( print page 31051)45800
17.7745805
20.7845820
18.4845825
21.2546700
9.1346750
10.2546753
8.2946760
14.4346761
13.8446762
12.71**Family 11 Hernia**49500
5.4849501
8.8849505
7.6049507
9.5749520
9.6349521
11.9749525
8.5749540
10.3949550
8.6349553
9.4449555
9.0349557
11.1549560
11.5749561
14.2549565
11.5749566
14.4049570
5.6949572
6.7349580
4.1149582
6.6549585
6.2349587
7.5649590
8.54**Family 12 A & B Stomach—Gastrectomy and Gastrectomy/Vagotomy**43620
30.0443621
30.7343622
32.5343638
29.0043639
29.6543631
22.5943632
22.5943633
23.1043634
25.1243640
17.0243641
17.27**Family 13 A & B Stomach—Incision/Excision/Repair**43500
11.0543501
20.0443502
23.1343510
13.0843520
9.9943605
11.9843610
14.6043611
17.8443800
13.6943810
14.6543820
15.3743825
19.2243830
9.5343832
15.6043840
15.5643870
9.6943842
18.4743843
18.6543846
24.0543847
26.9243848
29.39( print page 31052)43850
24.7243855
26.1643860
25.0043865
26.5243880
24.65**Family 14 A Abdomen, Peritoneum, Omentum**The RUC recommended no changes for codes 49000, 49002, 49010, 49200, 49201, 49220, 49255, 49900, 49421, 49422, 49425, 49426, and 49429.**Family 14 B Abdomen, Peritoneum, Omentum**49020
20.7349040
12.2749060
14.4049085
11.03**Family 14 C Abdomen, Peritoneum, Omentum**49428
6.06**Family 15 Appendix**44900
10.1444950
10.0044960
12.34**Family 16 Rectum—Proctectomy/Excision**45110
28.0045112
30.5445113
30.5845114
27.3245116
24.5845119
30.8445123
16.7145126
45.1645130
16.4445135
19.2845160
15.3245170
11.4945190
9.74**Family 17 Biliary Tract**47420
19.8847425
19.8347460
18.0447480
10.8247600
13.5847605
14.6947610
18.8247612
18.7847620
20.6447711
23.0347712
30.2447715
18.8047716
16.4447720
15.9147721
19.1247740
18.4847741
21.3447760
25.8547765
24.8847780
26.5047785
31.1847800
23.3047801
15.1747802
21.5547900
19.90**Family 18 Esophagus—Repair/Reconstruction**43320
19.93( print page 31053)43324
20.5743325
20.0643326
19.7443330
19.7743331
20.1343340
19.6143341
20.8543350
15.7843351
18.3543352
15.2643360
35.7043361
40.5043400
21.2043401
22.0943405
20.0143410
13.4743415
25.0043420
14.3543425
21.03**Family 19 Liver**47010
16.0147015
15.1147100
11.6747120
35.5047122
55.1347125
49.1947130
53.3547300
15.0847350
19.5647360
26.9247361
47.1247362
18.5147400
32.49**Family 20 A & B Spleen—Incision/Excision/Repair and Pancreatitis Management**38100
14.5038101
15.3138115
15.8248000
28.0748001
35.4548005
42.17**Family 21 Pancreatectomy**48020
15.7048100
12.2348120
15.8548140
22.9448145
24.0248146
26.4048148
17.3448150
48.0048152
43.7548153
47.8948154
44.1048155
24.6448180
24.7248500
15.2848510
14.3148520
15.5948540
19.7248545
18.1848547
25.83**Family 22 Laparoscopy**The RUC recommended no changes to the following codes based on lack of compelling evidence: 43651, 43652, 44200, 44970, 47562, 47563, 47564, 47570, 49320, 49650, and 49651.
 
 
 The RUC also recommended that the following codes be referred to the CPT Editorial Panel for review and clarification: 36533, 36534, 36535, 49495, and 49496. *HCFA Proposal:* The ACS conducted full surveys of 32 codes, and we agreed with the RUC analysis for most of the 32 codes. For the other codes the ACS did minisurveys that included pre-, intra-, and postservice times as well as the number and type of postservice visits. These minisurveys did not include an estimate of the relative work for the procedure. For this reason, the RUC used an extrapolation methodology to arrive at its work RVU recommendations for all codes that did not have a full RUC survey. To make appropriate extrapolations, the RUC divided all of the general surgery codes into families of related procedures. At least one code in each family was fully surveyed. After the RUC recommended work RVUs for each surveyed code, it applied the percent change for that code to all of the other codes in the family. When more than one code was fully surveyed within a family of services, the RUC extrapolated the percentage from the fully surveyed code that would produce the least increase in work RVUs. The validity of this extrapolation methodology relies on at least two things—first, that the relative work values of all codes in the family were correct before the extrapolation (or else the extrapolation perpetuates and magnifies any pre-existing anomalies), and second, that the relative misvaluation of each code in a family is similar. We did an analysis of all the families of codes in the general surgery group to determine whether the relative valuations in the 2001 physician fee schedule contained any anomalies. If any anomalies existed, we reviewed the RUC recommendations to determine whether the anomalies were addressed by the RUC recommendations. If the anomalies were not corrected, we took steps to correct them. We also analyzed all of the recommended values for general surgery to ensure that the percentage changes for each family were appropriate. To determine if the extrapolation for each family was correct, we compared each extrapolated code to codes in other families, and to codes in other specialties. We compared extrapolated codes to codes whose current or RUC recommended work RVUs (from the 5-year-review) were similar to the extrapolated code. We then compared the preservice, intraservice, and postservice physician times as well as the number of postoperative visits. In addition, we generally determined whether the survey vignette was typical for the procedure. The following is an example of our review of the general surgery codes. Code 35132 (
                        *Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for ruptured aneurysm, iliac artery (common, internal, external*) (30.00 work RVUs) with a preservice time of 67 minutes, intraservice time of 180 minutes, seven hospital visits, and three office visits is similar to codes 47712 (
                        *Excision of bile duct tumor, with or without primary repair of bile duct; intrahepatic*) (30.24 work RVUs) with a preservice time of 75 minutes, intraservice time of 210 minutes, one intensive care unit visit, nine hospital visits, and three office visits and 43638 (
                        *Gastrectomy, partial, proximal, thoracic or abdominal approach and esophagogastrostomy with vagotomy*) (29.00 work RVUs ) with a preservice time of 75 minutes, intraservice time of 210 minutes, 10 hospital visits, and 4 office visits. A review of these codes demonstrates the similarity in preservice and intraservice time and the proposed RVUs maintain relativity across surgical specialties. Upon completion of this analysis, we propose to accept the RUC recommendations for the following families of services: *Family 1A and 1B Thyroid and Endocrine.* *Family 3 Lymph Nodes and Lymphatic Channels—Incision/Excision.* *Family 4 Intestines—Excision/Incision.* *Family 5 Intestines—External Fistulization.* *Family 9 Anus/Rectum—10-day global period.* *Family 10 Anus/Rectum—Repair.* *Family 11 Hernia.* *Family 12 Stomach—Gastrectomy/Vagotomy.* *Family 13 Stomach—Incision/Excision/Repair.* *Family 14A and C Abdomen, Peritoneum, Omentum.* *Family 15 Appendectomy.* *Family 16 Rectum-Proctectomy/Excision.* *Family 17 Biliary Tract.* *Family 18 Esophagus—Repair/Reconstruction.* *Family 19 Liver.* *Family 20 Pancreas/Spleen—Incision/Excision/Repair.* *Family 21 Pancreatectomy.* *Family 22 Laparoscopy.* For the above families, adopting the RUC-recommended RVUs maintains relativity of the codes based upon a comparison of the codes to procedures in other families and within the family. For other families of services, the extrapolation methodology inappropriately values codes or does not address current rank-order anomalies. Application of the percentage increases derived from the RUC's extrapolation methodology would only exacerbate any current rank-order anomalies within families. Below, we have outlined, for each family of services, our proposed work RVUs to rectify these problems. Family 2 Lymphadenectomy The RUC recommended an increase in work RVUs for the fully surveyed code 38745 (
                        *Axillary lymphadenectomy; complete*) from 8.84 to 11.0 RVUs based on comparisons with codes 60210 (
                        *Partial thyroid lobectomy, unilateral, with or without isthmusectomy*), and 32100 (
                        *Thoracotomy, major with exploration and biopsy*). We disagree. Although codes 38745 and 60210 are performed in the outpatient setting and 32100 is not, code 38745 requires more postoperative wound care. Additionally, the RUC compared 38745 to the pre-5-year review value of 32100. Subsequently the RUC reviewed code 32100 for the 5-year review and is recommending an RVU increase to 15.24 RVUs. Because the intraservice times for codes 38745 and 32100 are identical and 38745 requires more postoperative wound care, a clear rank order anomaly would exist if 38745 was valued at 11.00 work RVUs and 32100 was valued at 15.24 work RVUs. Therefore, we are assigning the median survey RVUs of 13.00 to code 38745. We would also note that the survey RVU spread from the 25th percentile to the 75th percentile ranged from 12.15 to 14.29 RVUs, which is relatively small. An RVU of 13.00 places code 38745 in the correct rank order to the comparison codes. To maintain relativity within this family, we are extrapolating the 47 percent increase in work RVUs of code 38745 to codes 38740 (
                        *Axillary lymphadenectomy; superficial*) and 38760 (
                        *Inguinofemoral lymphadenectomy, superficial, including Cloquets node (separate procedure)*) for proposed work RVUs of 10.02 and 12.94, respectively. However, code 38765 (
                        *Inguinofemoral lymphadenectomy, superficial, in continuity with pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)*) represents a rank-order anomaly as it is currently valued too high relative to the other codes in the family. Therefore, we are accepting 
                        ( print page 31055)
                        the RUC recommendation for code 38765 of 19.98 work RVUs. Family 6 Colectomy The RUC recommended no change in the work RVUs for this family of codes based on lack of compelling evidence for changing the RVUs of the fully surveyed code 44140 (
                        *Partial colectomy*). Moreover, the intraservice time for code 44140 had not changed since the last 5-year review. Additionally, the RUC compared code 44140 to code 32480 (
                        *Removal of lung, other than total pneumonectomy; single lobe (lobectomy)*) and code 50230 (
                        *Nephrectomy, including partial ureterectomy, any approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy*) that have similar work RVUs to 44140 and were believed to be longer, more intense procedures with more postoperative care. We disagree with this recommendation. If the RVUs for procedures in this family are not changed, the procedures will be significantly undervalued compared to other general surgery codes (Family 5 and Family 7) and vascular surgery codes. As an example, we note that the RUC-recommended work RVU for code 44153 
                        *Colectomy, total, abdominal, without proctectomy; with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (S or J), with or without loop,*
                         will significantly undervalue this code compared to code 45113, 
                        *Proctectomy, partial, with rectal mucosectomy, ileoanal anastomosis, creation of ileal reservoir (S or J), with our without loop ileostomy,*
                         thus creating a rank-order anomaly. We compared code 44140 to code 32480 for which the RUC is recommending a work RVU increase to 23.75. These procedures have similar intraservice times, and the postoperative visits show that although the initial care required for code 32480 is more intense, the length of stay for code 44140 is frequently longer. We also compared code 44140 to codes 37617, 
                        *Ligation, major artery (eg post-traumatic, rupture); abdomen,*
                         and 35221, 
                        *Repair blood vessel, direct; intra-abdominal.*
                         Code 37617, for which the RUC recommended work RVUs of 22.06, is an emergency operation with a slightly shorter intraservice time and shorter hospital stay. Code 35221, which has RUC-recommended work RVUs of 24.39, is also an emergency operation with an intraservice time and length of stay identical to code 44140. Based on these comparisons, we believe that the survey's 25th percentile work RVUs of 21.00 are appropriate and correctly rank code 44140 to the comparison procedures. This increase is 14 percent greater than the current work RVUs and, with the exception of the two codes discussed below, applying this 14 percent increase to the other codes in this family will place them in proper relationship to other comparable procedures. Family 6 contains two current rank-order anomalies: code 44151, 
                        *Colectomy, total, abdominal, without proctectomy; with continent ileostomy,*
                         has lower work RVUs than code 44150, 
                        *Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy,*
                         and 44156, 
                        *Colectomy, total, abdominal, with proctectomy; with continent ileostomy,*
                         has lower work RVUs than code 44155, Colectomy, total, abdominal, with proctectomy; with ileostomy. Code 44151 is identical to code 44150, and code 44156 is identical to code 44155, except that codes 44151 and 44156 involve the creation of a “continent ileostomy” instead of an “ileostomy or ileoproctostomy.” The work of creating a “continent ileostomy” is greater than the work of creating an “ileostomy or ileoproctostomy.” To correct this rank-order anomaly, we applied the 14 percent increase discussed above to codes 44150 and 44155. Next, we determined the proper incremental increase in work for creation of a “continent ileostomy” by looking to codes 44310, 
                        *Ileostomy or jejunostomy, non-tube (separate procedure),*
                         and 44316, 
                        *Continent Ileostomy (Kock procedure) (separate procedure),*
                         because the work RVUs of 44316 are the same as the work RVUs of 44310 with the addition of creating a continent ileostomy. We subtracted the RUC-recommended work RVUs of 15.95 for code 44310 from the RUC-recommended work RVUs of 21.09 for code 44316 and divided by 50 percent (50 percent approximates the intraservice portion of the extra work). This resulted in work RVUs of 2.57 that we increased by 14 percent to yield work RVUs of 2.93. We then added 2.93 work RVUs to the RVUs for codes 44150 and 44155 to yield proposed work RVUs of 26.88 for code 44151 and 30.79 for code 44156. In summary, we propose the following work RVUs for the codes in this family: Code
Work RVUs44140
21.0044143
22.9944144
21.5344145
26.4244146
27.5444150
23.9544151
26.8844152
27.8344153
30.5944155
27.8644156
30.79
 With these assigned work RVUs, we believe that Family 6 is ranked appropriately in relation to other general and vascular surgery codes. Family 7 Intestines—Repair The RUC recommended an increase of 14 percent for all work RVUs in this family based on a recommended increase in a fully surveyed code 44604 
                        *(Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); without colostomy)*
                         from 14.28 work RVUs to 16.03 work RVUs. We agree with the increase in work RVUs for code 44604 but note that there are several rank-order anomalies currently in this family of codes that would be exacerbated by an across-the-board increase in work RVUs. Therefore, we propose to correct the rank-order anomalies as follows: We propose 16.03 work RVUs for 44602 
                        *(Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; single perforation).*
                         The work RVUs for code 44602 are identical to the work RVUs for code 44604 because they describe the same procedure except code 44604 is for the large intestine. We propose work RVUs of 19.53 for code 44605 
                        *(Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple perforations); with colostomy).*
                         The work RVUs for code 44605 are identical to the work RVUs for code 44604 except that code 44605 includes creating a colostomy with the attendant increase in postoperative wound care. The intraservice work of creating a colostomy is captured by subtracting the work RVUs for code 44140 from code 44143, which leaves 1.99 RVUs. In addition, there is one extra postoperative visit required for code 44605 that we believe is equivalent to code 99233 that has 1.51. work RVUs. Therefore, we added 1.99 and 1.51 work RVUs to the work RVUs for code 44604 to arrive at 19.53 work RVUs for code 44605. We propose 18.66 work RVUs for code 44603 
                        *(Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; multiple perforations).*
                         The additional work required for code 44603 as compared to code 44602 is similar to the additional work required for code 44605 
                        ( print page 31056)
                        as compared to code 44604 except, since there is no actual colostomy, the additional postoperative visit is comparable to code 99231 with 0.64 work RVUs. Therefore, we added work RVUs of 1.99 and 0.64 to the work RVUs of code 44602 to arrive at 18.66 work RVUs for code 44603. The current work RVUs for codes 44640 
                        *(Closure of intestinal cutaneous fistula);*
                         44650 
                        *(Closure of enteroenteric or enterocolic fistula);*
                         44660 
                        *(Closure of enterovesical fistula; without intestinal or bladder resection);*
                         and 44661 
                        *(Closure of enterovesical fistula; with bowel and/or bladder resection)*
                         are rank-order anomalies as they are undervalued compared to code 44604. However, relativity among codes 44640, 44650, 44660, and 44661 is appropriate. To correct the anomalies, we compared codes 44650 to 50525 
                        *(Closure of nephrovisceral fistula (eg renocolic) including visceral repair; abdominal approach),*
                         which involves similar intraoperative and postoperative work. The intraoperative work for code 50525 is greater than that of code 44650 because code 50525 involves visceral repair but the postoperative work for code 44650 is greater than the postoperative work for code 50525 because the fistula is enteroenteric or enterocolic as opposed to renovisceral (that is, renocolic). Therefore, we propose to assign 22.27 work RVUs to code 44650 and, to keep the current relativity with the other codes, we propose 21.65 work RVUs for code 44640, 21.36 work RVUs for code 44660, and 24.81 work RVUs for code 44661. We propose to accept the RUC recommendations for the remaining codes (44615, 44620, 44625, 44626, 44680, 44700, and 44850). Family 8 Anus/Rectum—Hemorrhoids/Fistula The RUC extrapolated a 14 percent decrease in work RVUs to all codes in this family based upon a decrease in work RVUs for the fully surveyed code 46262, 
                        *Hemorrhoidectomy, internal and external, complex or extensive; with fistulectomy, with or without fissurectomy.*
                         We agree with the RUC recommendation for the surveyed code, but disagree with the extrapolation to the anal fistula repair codes and the anal abscess treatment codes. The surveyed intraoperative time for code 46262 is not consistent with the surveyed intraoperative times for many of the other codes in the family. Moreover, the work RVUs for many of the codes subject to the minisurveys are significantly less than for code 46262 and are not comparable. Therefore, we propose to maintain the current RVUs for codes 46270, 46275, 46280, 46288, 45000, 45020, 45100, 45108, 46040, 46045, and 46060. We agree with the RUC recommendations and propose to decrease the work RVUs for other codes in this family of codes (46250, 46255, 46257, 46258, 46260, 46261, 46262, 46934, 46936, 46945, and 46946). Family 14B Abdomen, Peritoneum, Omentum The RUC recommended an increase for the fully-surveyed code 49020, 
                        *(Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; open,)*
                         from 16.79 work RVUs to 20.73 work RVUs, the 25th percentile of surveyed work RVUs, based on a comparison to code 61312 
                        *(Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural).*
                         We disagree and propose the surveyed median work RVUs of 22.84. We compared code 49020 to code 35151 
                        *(Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft insertion, with or without patch graft; for aneurysm, false aneurysm and associated occlusive disease, popliteal artery),*
                         48000 
                        *(Placement of drains, peripancreatic, for acute pancreatitis),*
                         and code 48140 
                        *(Pancreatectomy, distal subtotal, with our without splenectomy; without pancreaticojejunostomy).*
                         Code 48000 involves sicker patients but the intraoperative time (120 minutes) and postoperative visits (10-day length of stay for code 48000 with two critical care visits versus an 11-day length of stay for code 49020 with one critical care visit) are similar, and code 48000 has RUC-recommended work RVUs of 28.07. Code 48140, with RUC-recommended work RVUs of 22.94, has a longer intraoperative time (150 minutes) with a shorter length of stay (9 days with one critical care visit) and involves less sick patients. Code 35151, with RUC-recommended work RVUs of 22.64, involves patients not nearly as ill as patients for whom code 49020 is reported, has a surveyed intraoperative time of 150 minutes, and a 5-day length of stay with no critical care visits. Therefore, we propose the median surveyed work RVUs of 22.84 for code 49020. Since the current relativity within this family is correct, we propose to extrapolate this increase of 36 percent to the other codes in this family and value the work as follows: 49040 (13.52), 49060 (15.86), and 49085 (12.14). *Comment:*
                         The American Society of Colon and Rectal Surgeons collaborated with the ACS and submitted 12 codes for review that they believe to be undervalued. They also expressed support for the methodology proposed by ACS to value services. The specific codes referenced were: 44130, 44144, 44147, 44151, 44156, 44394, 45111, 45113, 45337, 45339, 45910, and 46258. *RUC Recommendation:* The RUC recommended increasing the work RVUs for the following codes: 44130 (14.49), 45113 (30.58), and 45910 (2.80) to retain current rank-order and relativity within the grouping of services. However, for code 46258, the RUC recommended decreasing the work RVUs to 5.73 to retain the current rank-order and relativity within these services. For codes 44147, 44394, 45111, 45337, 45339, 44144, 44151, and 44156, the RUC did not receive compelling evidence to suggest an increase was needed in the work RVUs; therefore, the RUC recommended that the current work RVUs for these codes be maintained. *HCFA Proposal:*
                         We propose to accept all but one of the RUC recommendations for the surgical codes submitted by the American Society of Colon and Rectal Surgeons. For code 44147, 
                        *Colectomy, partial; abdominal and transanal approach,*
                         we are proposing to increase the work RVUs by 14 percent to 20.71. This is similar to the increase applied to ACS family 6 and will prevent a rank-order anomaly. *Comment:*
                         The American Academy of Otolaryngology-Head and Neck Surgery submitted codes, on behalf of the American Otological Society and the American Academy of Facial Plastic and Reconstructive Surgery, that they believe to be undervalued, along with suggested new work RVUs for each service. However, subsequent to the submission of their comments, the specialty society chose not to pursue revaluing of the following codes: (69450, 69436, 69440, 69631, 69205, 69801, 69633, 69501, 69632, 69905, 69666, 69650, 69806, 69667, 69720, 69641, 69550, 69636, 69637, 69643, 69140, 69505, 69635, 69502, 69645, 69511, 69601, 69602, 69642, 69603, 69644, 69910, 69660, 69604, 69646, 69662, 69661, 69930, 69145, 69676, 69310, 69620, 69805, 69670, 69700, 69802, 69320, 69530, 69820, 68711, 69840, 69540, 69421, 69552, 69150, 69915, 69605, 69300, 69000, 69005, 69020, 69711, 69100, 69105, 69110, 69120, 69140, 69145, 691500, 69155, 69200, 69205, 69210, 69220, 69222, 69300, 69310, 69320, 69400, 69401, 69405, 69410, 69420, 69421, 69424, 69433, 69436, 69535, 69554, 69610, 69725, 69740, 69745, 69950, 69955, 69960, 69970). 
                        ( print page 31057) *RUC Recommendation:*
                         For codes 69990, 11642, 13131, and 13132, the RUC recommends no change to the current RVUs for these services, as compelling evidence was not provided to demonstrate the need for an increase. *HCFA Proposal:*
                         We have reviewed and propose to accept all of the RUC recommendations for the surgical codes submitted by the American Academy of Otolaryngology-Head and Neck Surgery. 3. Thoracic Surgery *Comment:*
                         In their comments, the Society of Thoracic Surgeons (STS) indicated that there have been major changes in the practice of thoracic surgery since the initial development of the physician fee schedule. These major changes in surgical techniques, along with changes in the typical patient, have had an impact on physician work. Time and intensity of a number of procedures, including the reference procedures used by STS, have been affected. The STS grouped codes into three categories: general thoracic surgery, adult cardiac surgery, and congenital thoracic surgery. These three categories were grouped into 23 families of codes. Each family had an anchor code that received a full RUC survey. Each of the remaining codes in a family received a minisurvey. The minisurvey collected information on time and the number of postoperative visits. The minisurvey also asked respondents to estimate work RVUs for the procedure based on the reference service for the family of codes. The RUC had a number of concerns with the STS approach. They are as follows: (1) The RUC concluded that STS inappropriately had the same survey respondents review and estimate both misvalued services and reference services. (2) In many instances, the respondents valued the code under review relative to their perception of what the reference code value should be, not the current value of the reference code. (3) The STS also used too many minisurveys and too few full surveys. (4) Within a family of codes, the STS inappropriately mixed codes with different global periods. To overcome these methodological problems, the RUC first reviewed the reference service that was used for each family, and the resulting value was compared to the codes in each family. For the adult cardiac surgery codes, the RUC developed a building-block methodology to validate the survey results. For the congenital thoracic codes, previous RUC reviews of the codes were used to determine how the work has changed since the last 5-year review. In addition, for the pediatric thoracic codes, the specialty's society's presenter offered additional information demonstrating that the patient population has changed, (for example, more neonates) leading to a higher intensity of work. Additionally, The STS subsequently chose not to pursue review of code 33207 under the 5-year review. *RUC Recommendations:*
                         The RUC reviewed 89 thoracic surgery codes. Of this total, the RUC recommended increases for 44 codes, no changes for 43 codes, and decreases for 2 codes. The recommendations by family are as follows: *Family 1:*
                         The RUC generally found that the STS had not furnished compelling evidence or that the STS inappropriately compared codes with a zero global period to codes with a 90-day global period. The RUC recommended no increase in work RVUs for codes 32000, 32005, 32020, 32035, 32225, 32602, 32651, and 32652. The RUC recommended increases in work RVUs for code 32220 (24.00) and code 32320 (24.00), based on the median surveyed work RVUs which would place these codes in proper rank order. *Family 2:*
                         The RUC recommended increases for code 32440 (25.00) based on the median survey value, and code 32480 (23.75) based on the value of 43415. The RUC also recommended increases in work RVUs for codes 32100 (15.24) and 32110 (23.00) based on a comparison to code 58150. These values place all these codes in proper rank order. *Family 3:*
                         The RUC recommended increases in codes 32482 (25.00) and 32500 (22.00), based on the STS surveyed median work RVUs for each code, which would create the proper rank order within the family of codes. *Family 4:*
                         The RUC recommended no increase for code 32655 because the STS had not furnished compelling evidence for an increase in work. The RUC recommended increases for codes 31600 (7.18) and 32500 (22.00) based on survey data, a sicker patient population, and, in the case of 31600, comparison to 35474. *Family 5:*
                         The RUC recommended increases for codes 38746 (4.89) based on the work RVU for 38747, but recommended no increases for codes 39010, 39220 or 39400 due to lack of compelling evidence or inappropriate comparisons to codes with 90-day global periods. *Family 6:*
                         The RUC agreed with the STS analysis of work for codes 43107 (40.00) and 43112 (43.50) and stated that using the survey median for each code correctly rank ordered these codes in the family of esophagectomy codes. *Family 7:*
                         The RUC recommended an increase for code 43117 (40.00) after comparing it to the reference service code 43361 which had similar data. The RUC also recommended an increase for code 43122 (40.00) based on the survey median of 40.00 work RVUs which correctly rank ordered this code in the family of esophagectomy codes. *Family 8:*
                         The RUC recommended no increase for codes 31625 or 31645 because the STS did not furnish compelling evidence for an increase in work. *Family 9:*
                         The RUC recommended increases for the following codes: 33400 (28.50), 33405 (35.00), 33406 (37.50), 33411 (36.25), 33412 (42.00), and 33413 (43.50), based on a building-block approach that used code 33405 as the anchor code for this family. *Family 10:*
                         The RUC recommended increases for the following codes: 33426 (33.00), 33427 (40.00), 33430 (33.50), and 33475 (33.00), based on a building-block approach that used code 33427 as the anchor code for this family. The RUC recommended no increases for codes 33425 or 33468 because the building-block approach did not support the STS's requested increase. *Family 11:*
                         The RUC recommended increases for the following codes: 33510 (29.00), 33511 (30.00), 33512 (31.80), and 33513 (32.00), based on a building-block approach that used code 33512 as the anchor code for the family. The RUC recommended decreases for codes 33514 (32.75) and 33516 (35.00). These were the values recommended by the STS and validated through the building-block approach. *Family 12:*
                         The RUC recommended no increases for the following add-on codes: 33517, 33518, 33519, 33521, 33522, 33523, and 33530, because it believes that they were inappropriately surveyed as 90-day global procedure codes and the results were not reliable. *Family 13:*
                         The RUC recommended increases in work RVUs for the following codes: 33533 (30.00), 33534 (32.20), 33535 (34.50), and 33536 (37.50), based on a building-block approach that used code 33533 as the anchor code for the family of codes. The RUC recommended no increase for code 33530 because it is an add-on code and was inappropriately surveyed as a 90-day global surgical procedure. *Family 14:*
                         The RUC recommended increases in work RVUs in the following codes: 33860 (38.00), 33861 (42.00), 33863 (45.00), and 33870 (44.00) based on a building-block approach that used code 33860 as the anchor code for the family. The RUC recommended no increase for code 33945 because the building-block approach did not 
                        ( print page 31058)
                        support the higher value requested by the STS. *Family 15:*
                         The RUC recommended no increases in work RVUs for the following codes:  33750, 33820, and 33840, due to lack of compelling evidence to support an increase. *Family 16:*
                         The RUC recommended an increase in code 33660 (30.00) based on intraservice work RVUs for 33401 and pre- and postservice work RVUs for 33641. The RUC recommended no increase in code 33641 as it did not find any compelling evidence to warrant a change in the work RVUs. *Family 17:*
                         The RUC recommended no increase in work RVUs for code 33415, because it did not believe that the typical patient for this procedure has changed, and the minisurvey did not provide compelling evidence to justify a change in the work RVUs. However, the RUC recommended an increase in work RVUs in code 33681 (30.61), because the intraservice intensity of 33681 is more complex than it was 5 years ago. *Family 18:*
                         The RUC recommended increases in the following codes: 33615 (34.00), 33670 (35.00), and 33730 (34.25) based on a comparison to code 33412. *Family 19:*
                         The RUC recommended increases in work RVUs for the following codes: 33611 (34.00), 33612 (35.00), 33694 (34.00) and 33697 (36.00). The RUC compared the intraservice time of code 33611 to the family anchor code of 33694 and recommended 34.00 work RVUs to maintain proper rank order in the family. The RUC compared code 33612 to code 33611 and agreed code 33612 was equivalent to 33611 plus 1 additional work RVU. The RUC compared code 33694 to 33412 and concluded that all measures of physician work were greater for 33694. The RUC compared code 33697 to 33694 and recommended 36.00 work RVUs to maintain rank order. The RUC recommended no increase for 33767 because there was no compelling evidence for a change in the work RVUs. *Family 20:*
                         The RUC recommended an increase in code 33617 (37.00), after comparing it to code 33412 and noting that 33617 has greater intraservice time and higher intensity ranking than code 33412. *Family 21:*
                         The RUC recommended an increase in code 33619 (45.00) after comparing it to codes 48150 and 62530. *Family 22:*
                         The RUC recommended an increase in code 33506 (35.50) to preserve proper rank order within this family. The RUC recommended an increase in code 33770 (37.00) after finding that the work of this code is more than that of the comparison code 33697. The RUC recommended an increase in code 33778 (40.00), after comparing it to 33870, and 33412 which are less intense procedures. The RUC recommended an increase in code 33780 (41.75), based on a comparison to 33778. 33780 involves more work and warrants an additional 1.75 RVUs due to the additional 35 minutes of intraservice time. *Family 23:*
                         The RUC recommended an increase in code 33786 (39.00) after comparing it to 33412, which has less time and intensity. Given the limited specialty survey data, the RUC believed that the recommended increase in code 33919 to 40.00 work RVUs was warranted, but that the survey did not support a value higher than the median survey value. Based on information supplied to the RUC, the RUC did not recommend a change in RVUs for codes 32520, 33917, 31622, and 32657. For codes 32095, 33410 and 32491, the RUC indicated that it had recently reviewed these codes, and thus it recommended no change. The RUC recommended that codes 33875, 33877, 43107, and 43112 be referred to the CPT Editorial Panel. *HCFA Proposal:* We validated the RUC recommendations by comparing the thoracic surgery codes to vascular surgery and general surgery codes and propose to use the RUC-recommended work RVUs for the thoracic codes based on our own analysis. The following is an example of our review of the thoracic surgery codes. We compared code 32440 (
                        *Removal of lung, total pneumonectomy*) (25.00 work RVUs) with a preservice time of 90 minutes, intraservice time of 160 minutes, one intensive care unit visit, six hospital visits, and three office visits with the following surgical codes in other surgical specialties: code 34151 (
                        *Embolectomy or thrombectomy, with or without catheter; renal, celiac, mesentery, aortoiliac artery, by abdominal incision*) (25.00 work RVUs) with a preservice time of 75 minutes, intraservice time of 150 minutes, seven hospital visits, and three office visits and code 44150 (
                        *Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy*) (23.95 work RVUs) with a preservice time of 63 minutes, intraservice time of 200 minutes, eight hospital visits, and three office visits. A review of these codes demonstrates the similarity in preservice time and intraservice time and the proposed RVUs maintains relativity across surgical specialties. 4. Orthopedic Surgery *Comment:*
                         The American Academy of Orthopaedic Surgeons forwarded 42 codes for review. It indicated that these codes were undervalued when compared to their respective reference codes. *RUC Recommendation:* The RUC recommended increasing the work RVUs for the following codes: 29883 (11.05) because this service consists of two procedures; 29889 (16.00) based on increase in post and intraservice work; 29450 (2.08) based on the increased intraservice time for manipulating the foot of the patient; code 28299 (9.18) which is of value equal to the reference code, with the understanding that the code be sent to CPT Editorial Panel to better define the code; code 28705 (18.80), which more accurately reflects the work of the two distinct services of this procedure (ankle fusion and triple arthrodesis); code 23472 (21.10) to correct a rank-order anomaly; code 26562 (15.00) to correct a rank-order anomaly; code 20245 (8.50) to correct a rank-order anomaly; code 27075 (35.00) noting that this is a major operation and there is increased intraservice time with respect to the reference code; code 27077 (40.00) noting that this a major operation and there is increased intraservice time with respect to the reference code; 27284 (23.45) because this is the value for code 27227 that has identical pre-, intra-, and postservice times; code 27286 (23.45) to avoid creating a rank-order anomaly due to the recommended work RVUs increase of code 27284; code 27822 (11.00) to correct an existing rank-order anomaly; code 27823 (13.00) to avoid creating a rank-order anomaly caused by increasing code 27822; code 28445 (15.62) to correct a rank-order anomaly and appropriately reflect the work involved; code 27724 (18.20) to reflect the work for obtaining a graft that was not included in the last 5-year review. The RUC believed that the commenter provided no compelling evidence to revise the work RVUs for codes 27280, 27282, 23585, 23615, 23630, 23680, 24545, 27216, 27217, 27218, 27226, 27236, 27513, 27536, 27828, 23485, 24435, 27472, 28322, and 28420. Therefore, the RUC recommended the current work RVUs be maintained for these codes. The RUC referred the following codes to the CPT Editorial Panel for clarification: 23076, 24076, 25076, 27048, 27328, 27619, and 20205, because these codes are being reported incorrectly. *HCFA Proposal:*( print page 31059) We propose to accept all but one of the of the RUC recommendations for the orthopedic surgery codes. For code 20245, (
                        *Biopsy, bone, excisional; deep (eg, humerus, ischium, femur*), the RUC recommended an increase from 3.95 work RVUs to 8.5 work RVUs and compared code 20245 to codes 27635 (
                        *Excision or curettage of bone cyst or benign tumor, tibia or fibula*), and 27607 (
                        *Incision (eg, osteomyelitis or bone abscess), leg or ankle*) (work RVUs of 7.78 and 7.97, respectively), because it believed the work required for code 20245 was similar to the work required for these codes. The survey for code 20245 compared the code to code 27635. The intraservice times were similar (90 versus 85 minutes) and the amount of postservice was similar (169 versus 163 minutes). However, the survey median work RVUs were 13 and the 25th percentile RVUs were 8.5. The RUC recommended the 25th percentile RVUs because the RVUs were reasonably close to the RVUs for code 27635. We agree that the current work RVUs are a rank-order anomaly with code 20240 (
                        *Biopsy, bone, excisional; superficial (eg, ilium, sternum, spinous process, ribs, trochanter or femur*)); however, we disagree with the RUC recommendation. The intraservice work of a deep excisional bone biopsy is similar to the work of excising a bone cyst or benign tumor from the tibia and fibula (code 27635). This is reflected in the similarity in their pre-, intra-, and postservice times. Moreover, the vignette used for code 20245 was atypical in that it involved an ischial lesion, whereas the code is also to be reported for lesions of the humerus and femur. Lesions of the humerus and femur require less dissection and would be more comparable to lesions of the tibia and fibula. Moreover, code 27635 requires complete removal of a known lesion, whereas code 20245 is only an excisional biopsy. Additionally, we are concerned about the spread of work RVUs in the work survey (25th percentile was 8.5 RVUs and 50th percentile was 13.0 work RVUs) and lack of consistency with the time data from the survey. We do not believe there is compelling evidence that the work of code 20245 is greater than the work of code 27635 and are therefore proposing to assign 7.78 work RVUs to code 20245, which is identical to work RVUs for the reference service code 27635. 5. Ophthalmology *Comment:*
                         The American Academy of Ophthalmology submitted comments requesting nine codes be reviewed, including one code for evaluation of the global period and not the work RVU. The specialty society subsequently chose not to pursue review of codes 66170, 66172, and 67108. *RUC Recommendation:* The RUC agreed with the request from the specialty society to change the global period from 90 days to 10 days for code 65855 (
                        *Laser surgery of eye*) and also reduced the work RVUs to 3.85 to account for this reduction in the global period. The RUC noted that code 67218 includes two procedures, and the specialty society indicated that this was not reflected in the original valuation. To correct this error, a building-block approach was used to arrive at new RVUs more reflective of the work of both procedures. The RUC recommended work RVUs of 18.53 for this service. For code 92018, the RUC acknowledged that the preservice work of this service was greater than the standard office procedure because of the need for anesthesia. While concerned about the reliability of the data provided, the RUC recommended that the work RVUs be increased to 2.50, as it suggested during the first 5-year review, with the understanding that the code would be sent to the CPT Editorial Panel for clarification. For codes 66180, 66986, 67028, and 67904, the RUC believed that the commenters provided no compelling evidence to justify an increase in the work RVUs; therefore, the RUC recommended maintaining the current value for this code. *HCFA Proposal:* We have reviewed and propose to accept all of the RUC recommendations for the ophthalmology codes. 6. Urology *Comment:*
                         The American Urological Association presented four codes for review: 50230, 51595, 51596, and 38780. They believed that the work RVUs for these codes do not account for all the in-hospital and office-based postoperative care. *RUC Recommendation:* The RUC questioned the arguments for an increase in RVUs, noting that there was no compelling evidence presented for recommending an increase for three of these codes (51595, 51596 and 38780). However, the RUC noted that the code descriptor for code 50230 includes the term “and/or vena caval thrombectomy” which impacts the work RVU. The RUC agreed to refer this code back to the CPT Editorial Panel to separate these two distinct services so each may be reported and valued appropriately. *HCFA Proposal:* We have reviewed and propose to accept all of the RUC recommendations for the urology codes. 7. Obstetrics/Gynecology a. Specialty Comments *Comment:*
                         The American College of Obstetrics and Gynecology (ACOG) referenced 35 codes in their written comments submitted to us. The specialty society chose not to pursue the review of work RVUs for code 57555, as well as the work RVUs for codes 59150 and 59151. *RUC recommendation:* The RUC recommended increases in the RVUs for the following codes: 38572 (16.59) that would align the code relative to the work of other laparoscopic codes; 56515 (2.76), which was not the value requested by the specialty group but was the value assigned to code 46924, which has comparable work and intraservice time; 56740 (4.57) based on a modified building-block approach, which was similar to ACOG's approach; 57100 (1.20) as presented by the specialty society; 58152 (20.60) in recognition that the current work RVUs are less than the RVUs for code 58150 performed alone even though 58152 combines the work of codes 58150 and 58840; 58260 (12.98) to reflect work of additional office visits included in the procedure; 58262 (14.77) to accurately reflect the work of its component procedures; 58263 (16.06), 58275 (15.76), 58270 (14.26) and 58280 (17.01) to maintain relativity within family of hysterectomy codes; 58267 (17.04) because the procedure is currently undervalued since it encompasses three separate components; 58285 (22.26), which was lower than requested by the specialty group, but which the RUC believed was more reflective of the work for the procedure; 58600 (5.60) based on similarity of this procedure to code 58670; 58605 (5.00) to reflect the slightly lower pre-, intra-, and post-times for this code as compared to 58670; 58611 (1.45) to appropriately reflect the increase in preservice work; 58700 (12.05) reflecting the higher technical skill associated with this procedure (removing only fallopian tube versus ovary and fallopian tube); 58740 (14.00) to reflect increase in intra-service time and postoperative work; 58825 (10.98) which aligns the work value with other codes with similar work; 58920 (11.36) to correct a rank-order anomaly; 58950 (16.93) which combines both codes 58720 and 49255 and applies the multiple procedure rule; 58951 (22.38) based on the similarity of work to 58285 which has the same 
                        ( print page 31060)
                        recommended value; 59812 (4.01) based on the similarity of work to code 59820; 59870 (6.01) based on increased physician work and postoperative time. The RUC indicated that the commenter provided no compelling evidence to support an increase in the work RVUs for codes 38571, 57130, 57292, 57307, 57505, 58323, 58400, and 58805. For code 58820, the RUC indicated that this service had recently been reviewed by the RUC and, therefore, the current work RVUs should be maintained. *HCFA Proposal:* We have reviewed and propose to accept all of the RUC recommendations for the obstetrics/gynecology codes. b. Other Concerns We have been alerted to concerns that certain female-specific procedures may be undervalued. Our staff has reviewed the work RVUs associated with a number of female-specific procedures, including major and minor surgical procedures as well as several laparoscopic procedures and has determined that, for the most part, the RVUs assigned seem reasonable and consistent with the time, intensity, and postoperative care involved with the procedures. However, there were several codes that seemed to be inappropriately valued as compared to other similar procedures. These procedures are: code 56515 (
                        *Destruction of vulvar lesions, extensive*); code 57100 (
                        *Biopsy of vagina*); code 56605 (
                        *Biopsy of vulva*); code 58100 (
                        *Biopsy of endometrium*); and code 56810 (
                        *Perineoplasty*). We forwarded two of these codes (codes 56515 and 57100) to the RUC for review under the 5-year refinement process, and the RUC has recommended an increase in work RVUs for both of these codes. We have referred the remaining three codes that appear to be misvalued to the RUC for review, and we anticipate receiving a response from the RUC that we can consider in the November 1, 2001 final rule. 8. Gastroenterology *Comment:*
                         The American Society for Gastrointestinal Endoscopy (ASGE), American College of Gastroenterology (ACG), and the American Gastrointestinal Association (AGA) provided comments describing gastrointestinal services that they believed to be misvalued. Their comments focused on the identification of specific services whose work RVUs they believe are too low in comparison to other gastroenterology services when comparing time and intensity of the procedures. They also expressed concern that the work RVUs for all gastroenterology procedures involving conscious sedation are substantially undervalued and need to be increased because of the added requirements associated with conscious sedation. *RUC Recommendation:* With regard to conscious sedation, the RUC was concerned about—(1) The need to break out different levels of physician work for conscious sedation, and (2) many gastroenterology codes have been previously valued with conscious sedation included and some codes were not valued with conscious sedation included. Therefore, the RUC agreed to create a joint RUC and CPT workgroup to review and define the issues related to conscious sedation. Based upon information presented by the specialty at the February 2001 RUC meeting, the RUC agreed that elements of conscious sedation have changed over the past 5 years; however, the RUC was not able to quantify the change in physician work. While the RUC did not recommend a specific increase, it did recommend and urge us to allow separate reporting and payment of conscious sedation codes 99141 and 99142 when conscious sedation is not inherently included as a component of the physician work of the procedure. Based on technological advances, increased complexity in procedure, and changes in patient population the RUC recommended an increase in work RVUs for the following codes: 43219 (3.18); 43239 (2.87); 43244 (5.05); 43247 (3.59): 43249 (3.35); 43255 (4.82); 43259 (8.59); 43263 (7.29); 43265 (10.02); 43269 (8.21); 44388 (3.70); 44389 (4.26); 44390 (4.81); 44391 (5.18); 44392 (4.81); 44393 (5.00); and 45380 (4.44). Based on the lack of compelling evidence to increase the work RVUs, the RUC recommended that the current work RVUs be maintained for the following codes: 43217, 43228, 43246, 43251, 43258, 44394, 45383, 45384, and 45385. *HCFA Proposal:* The RUC reviewed a selected series of gastrointestinal endoscopy codes for the 5-year review. These codes included endoscopy of the esophagus, stomach, duodenum, small intestine, large intestine, stoma, and biliary tree. The RUC recommended increases in work RVUs for some of the codes and no change in work for other codes. Unfortunately, the RUC could not review all of the endoscopy codes in each family and, therefore, was in the position of having to make recommendations that would likely cause new rank-order anomalies or exacerbate existing rank-order anomalies within and among these families. Furthermore, creation of rank-order anomalies across specialties was also likely. For example, a bronchoscopic biopsy would be valued significantly less than a gastrointestinal endoscopic biopsy if the gastrointestinal endoscopic biopsy was increased in value. Although we are concerned that some of these endoscopy codes may be misvalued, we are proposing to keep all work RVUs for gastrointestinal endoscopy codes unchanged. However, we believe that a comprehensive review of the work RVUs for all gastrointestinal endoscopy codes is warranted. Therefore, we are asking the RUC to perform a comprehensive review of all gastrointestinal endoscopy codes to ensure that all codes are properly valued, and that no rank-order anomalies within and across specialties are created or exacerbated. We hope to receive recommendations from the RUC for these codes in time for the proposed physician fee schedule regulation in 2002. Below we discuss our reasons for proposing to reject the recommended work increases for each code. However, we note that many new gastrointestinal endoscopy CPT codes were created for use in 2002 and reviewed by the RUC concurrent with the 5-year review. Recommendations for these new codes were made by comparing them to the current work RVUs of existing gastrointestinal endoscopy codes, some of which were reviewed as part of the 5-year review. Therefore, any increases in work RVUs for codes in the 5-year review will likely invalidate the work RVUs for many of the new codes reviewed by the RUC. Furthermore, proposals have been made for even more gastrointestinal endoscopy CPT codes for CYs 2002 and 2003. We want to ensure that these new codes are properly reviewed and appropriate work RVUs assigned. Until a comprehensive review of all gastrointestinal endoscopy codes is performed we do not believe this is possible. Code 43219, 
                        *Esophagoscopy, rigid or flexible; with insertion of plastic tube or stent:* The RUC recommended an increase in work RVUs from 2.8 to 3.18 based upon the increased complexity of the condition of patients receiving these stents. The current work increment between this code and 43200 (1.21 RVUs) has been used extensively by the RUC to make recommendations for other endoscopic stent placement procedures. Therefore, in spite of this recommendation, it appears that the RUC and the specialists who perform 
                        ( print page 31061)
                        this procedure agree that the correct increment for stent placement is 1.21 work RVUs. If the work RVUs for code 43219 were accepted, many other recommendations from the RUC would need to be reevaluated. Furthermore, it is unclear from the vignette used to value this procedure whether or not predilation of the esophagus was included in the work of this code. Currently, code 43226 describes the work of predilation and may be billed in addition to code 43219. The incremental work for placing a tracheal stent with predilation (the difference in work between codes 31622 and 31631) is 1.59 work RVUs. This is significantly less than the current work increment for esophageal stent placement with predilation, 1.96 (1.21 + .75). Additionally, the vignette describes placement of an expandable wire mesh stent but the code is also used for plastic stents, placement of which may require less work. We propose maintaining the current RVU for this code in view of these concerns and the rank-order anomalies that would be created by accepting the RUC recommendation. *Code 43239 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with biopsy, single or multiple):* The RUC recommended an increase in work RVUs from 2.69 to 2.87 based on a larger number of biopsies obtained during a procedure. The RUC also stated that technological advances allowing for greater precision and detail in finding abnormalities have increased the need for this service. The RUC also stated that technological advances have allowed for more immediacy of results which increases the post service work in conveying the biopsy information and treatment guidance to the patient. We would note that the current work increments for all endoscopic gastrointestinal biopsy codes (described as the base procedure with “biopsy, single or multiple”) are 0.3 RVUs. Accepting the RUC recommendation would increase this increment to 0.48 work RVUs while keeping all the other biopsy increments at 0.3 work RVUs, creating a clear rank-order anomaly. Furthermore, this code is used for “single” biopsies, and, with the increase in work, these biopsies would be overvalued. We also do not understand how technological advances in locating lesions and getting more immediate results increases the work of the procedure itself. Therefore, we propose maintaining the current work RVU for this procedure. *Code 43244 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with band ligation of esophageal and/or gastric varices) and 43255 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with control of bleeding, any method):* The RUC recommended an increase in work RVUs for code 43255 from 4.4 to 4.82 work RVUs based on new technology, such as lasers, to control bleeding. The RUC also states that this new technology increases the intensity of the procedure. However, the vignette used to survey code 43255 describes use of cautery to control bleeding. The work for this code must be appropriate for all methods of controlling bleeding and the vignette must represent the typical case. The current work increment for “control of bleeding, any method” for gastrointestinal endoscopic procedures is 2.01 work RVUs. Acceptance of the RUC recommendation for code 43255 would make this work increment 2.43 RVUs, for upper gastrointestinal endoscopy only, creating a clear rank-order anomaly. The RUC recommended an increase in work RVUs for code 43244 from 4.59 to 5.05 RVUs, based on the increased number of bands used to treat esophageal varices. However, the RUC agreed that the work RVUs for code 43244 were similar to the work RVUs for code 43255. Therefore, accepting the RUC recommendation for code 43244 and not code 43255 would create a clear rank-order anomaly. We believe that these two codes should have similar work RVUs. Therefore, we propose to maintain the current work RVUs for these procedures. *Code 43247 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body):* The RUC recommended an increase in work RVUs for this code from 3.39 to 3.59 work RVUs based on increased complexity of the condition of patients undergoing this procedure with a concomitant increase in risk of morbidity. The RUC used a building-block approach to validate its acceptance of the median work RVUs from the survey. We do not fully understand the building-block analysis the RUC used but believe it was invalid. Moreover, the current work increment for “removal of foreign body” for gastrointestinal endoscopy procedures is 1.0 work RVUs. Acceptance of the RUC recommendation would create a clear rank-order anomaly. Therefore, we propose to maintain the current work RVUs for this procedure. *Code 43249 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with balloon dilation of esophagus (less than 30mm diameter)):* The RUC recommended an increase from 2.9 to 3.35 work RVUs for this code based on increased complexity of the condition of patients undergoing this procedure. The current work increment for “balloon dilation of esophagus (less than 30 mm diameter)” is 0.51 RVUs for both the esophagus and upper gastrointestinal endoscopy families. Since this is the same procedure in both families, it is unclear why the work should be increased to 0.96 work RVUs for the upper gastrointestinal family only. Accepting the RUC recommendation would create a clear rank-order anomaly. Therefore, we are proposing to maintain the current work RVUs for this code. *Code 43259 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination):* The RUC recommended an increase in work RVUs from 4.59 to 8.59 based on the complexity of the equipment and the skill and judgement required. The RUC also noted that the survey results supported this procedure as more difficult than an 
                        *endoscopic retrograde cholangio-pancreatography (ERCP).*
                         The RUC then used the following building-block methodology: (1) The RUC added 1.5 work RVUs, which was approximately 75 percent of the difference between the RUC recommendation from the last 5-year review (6.11 work RVUs) and the work RVUs that we assigned (4.0 work RVUs). (2) The RUC then added 2.2 work RVUs, which are the work RVUs of code 93312. Not only do we disagree with the RUC methodology for this recommendation, but we also note that the RUC has used the current work RVUs for code 43259 to value not only other gastrointestinal transendoscopic ultrasound procedures but also many transendoscopic ultrasound guided biopsy codes. We would also note that the RUC has recently re-evaluated code 43231, 
                        *Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination,*
                         and will be sending a new recommendation to us regarding the work valuation of this procedure. Accepting the RUC recommendation for this code would be inconsistent with the RUC's reevaluation of code 43231, would invalidate the work valuation of many other gastrointestinal endoscopy 
                        ( print page 31062)
                        codes, and would create numerous rank-order anomalies. Therefore, we propose to maintain this code at its current work RVUs. *Codes 43263 (Endoscopic retrograde cholangio-pancreatography (ERCP); with pressure measurement of sphincter of Oddi (pancreatic duct or common bile duct)),*
                         43265 
                        *(ERCP; with endoscopic retrograde destruction, lithotripsy of stone(s), any method),*
                         and 43269 
                        *(ERCP; with endoscopic retrograde removal of foreign body and/or change of tube or stent):* The RUC recommended an increase in work RVUs from 6.19 to 7.29 for code 43263 based on the need to measure pressures in both the biliary and pancreatic sphincters as well as the need for prolonged postoperative monitoring. The RUC arrived at its recommendation by adding 1.1 work RVUs (the value of code 99214) to the current work RVUs. We disagree with valuing a post procedure observation period as equal to an evaluation and management service. Furthermore, increasing the value of this code while not adjusting the values of codes 43262, 43267, and 43268 creates clear rank-order anomalies. The RUC recommended an increase in work RVUs from 8.9 to 10.02 for code 43265 based on a rank-order anomaly with code 43264. The RUC compared survey times to the Harvard study times for this code and used a building-block method to arrive at its recommendation. We do not fully understand the RUC methodology and disagree with the conclusion. The Harvard study time data show less time for code 43265 than for code 43264, which would indicate that the current valuations of these codes are correct. Moreover, increasing the value of 43265 while not adjusting codes 43264, 43267, and 43268 would create clear rank-order anomalies. The RUC recommended an increase in work RVUs from 6.04 to 8.21 for code 43269 based on a rank-order anomaly between this code and code 43268. The RUC used a building-block methodology adding 0.82 work RVUs to the work RVUs of code 43268 (7.39) to arrive at its recommendation. We disagree with the RUC methodology of using an evaluation and management service to arrive at its recommendation since this is an invasive procedure. Furthermore, we believe increasing the value of this code creates a rank-order anomaly with codes 43271 and 43272. Therefore, we are proposing maintaining the current work RVUs of all three of these codes. *Codes 44388 (Colonoscopy through stoma; diagnostic with or without collection of specimen(s) by brushing or washing (separate procedure)),*
                         44389 
                        *(Colonoscopy through stoma; with biopsy, single or multiple),*
                         44390 
                        *(Colonoscopy through stoma; with removal of foreign body),*
                         44391 
                        *(Colonoscopy through stoma; with control of bleeding, any method)*
                         44392 
                        *(Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery),*
                         and 44393 
                        *(Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique).* These codes are in the same family of codes, and the RUC recommended increases in work RVUs for all these codes based on a misvaluation of the base code in this family of codes, code 44388. The RUC valued it similarly to code 45378. We disagree. We think this creates a clear rank-order anomaly between the value of this family and the value of the colonoscopy family of codes beginning with code 45378. Colonoscopy through a stoma is clearly less work than colonoscopy of the complete colon and it has been valued as such since the inception of the physician fee schedule. We question the accuracy of the surveyed intraservice time for this service. Because of our nonacceptance of the increase in work RVUs for the base code in this family, we must also not accept the recommendations for all other increases in work RVUs for other codes in this family. Moreover, the recommendations create increments of work for “biopsy, single or multiple,” “removal of foreign body,” “control of bleeding, any method,” “removal of tumors,” and “ablation of tumors,” which are inconsistent with the same increments for the colonoscopy family of codes beginning with code 45378. Accepting these RUC recommendations would create clear rank-order anomalies that do not currently exist. Therefore, we are proposing to maintain the current work RVUs for these procedures. *Code 45380 (Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple).* The RUC recommended an increase in work RVUs from 3.98 to 4.44 for this code based on the increased number of biopsies generally taken during this procedure and the increased difficulty in removing these polyps. The current work increment for “biopsy, single or multiple” for gastrointestinal endoscopic procedures is 0.3 work RVUs. Accepting the RUC recommendation would create a clear rank-order anomaly. Moreover, we note that this code is also used for single biopsies that would become significantly overvalued if we accepted the RUC recommendation. Therefore, we are proposing to maintain the current work RVUs for this code. In summary, we believe the only way to accurately value gastrointestinal endoscopy procedures is to evaluate the entire series of codes, including all families of codes (esophagus, upper gastrointestinal, ERCP, and colonoscopy etc.) at the same time. Only then can appropriate incremental work RVUs be determined without creating rank-order anomalies. We would also suggest that the RUC consider reorganization of all these codes to facilitate more accurate coding (for example, to determine whether every family of codes needs a code for “removal of foreign body” or whether the base code be revalued to include more procedures than it currently does). We suggest that while the RUC is reevaluating these codes that it delay making recommendations on any new codes for this series so that conflicting recommendations are not made and the chance of creating rank-order anomalies is minimized. With respect to the RUC recommendation concerning reporting and payment of conscious sedation codes 90141 and 90142, we will be reviewing data concerning this issue. Any proposals we would have concerning payment and reporting of conscious sedation codes would be the subject of future rulemaking. 9. Pulmonary Medicine/Critical Care *Comment:*
                         Several specialty groups, including the societies for pulmonary medicine and critical care, indicated that codes 36620 and 36489 were undervalued. Commenters indicated that the work RVUs for code 36489 should be greater than the work RVUs for the reference service code, 36010, because there is more work involved. Commenters also stated that code 36620 is undervalued as compared to the reference code 36140, because there are more variables affecting the work involved with this procedure. These specialty groups also requested that codes 99291 and 99292 be evaluated because the groups claimed they were undervalued. *RUC Recommendation:* For code 36489, the RUC noted that there is additional work and postoperative time involved in this procedure as compared to that of the reference service code 36010, and recommended work RVUs of 2.50 which are higher than the reference service code 36010 (2.43), which corrects the rank-order anomaly. With respect to 36620, the RUC compared this 
                        ( print page 31063)
                        procedure to the reference service (code 36140) and agreed that this service appeared to be undervalued. However, the RUC was concerned that anesthesiologists who perform this procedure over 80 percent of the time did not comment or participate in the survey conducted by the specialty groups. The RUC concluded that code 36620 should be referred to the CPT Editorial Panel to clarify the appropriate use of this code. The RUC recommended maintaining the work RVUs for critical care services (codes 99291 and 99292) due to the lack of compelling evidence to recommend an increase in the work RVUs above the 2001 work RVUs of 4.00 and 2.00, respectively. *HCFA Proposal:* We have reviewed and propose to accept all of the RUC recommendations for the pulmonary medicine and critical care codes. 10. Cardiology *Comment:*
                         The American College of Cardiology (ACC) recommended review of three procedure codes under the 5-year refinement. They are code 93350, which was not reviewed during the first 5-year review but which the ACC believes is undervalued; and codes 33234 and 33235, which ACC argues are undervalued because it does not believe the codes reflect the level of difficulty associated with the procedures. *RUC Recommendation:* The RUC supported an increase in the work RVUs for code 93350 to account for the increased work and more complex conditions of the patient population as supported by survey information submitted. The RUC recommendation was to increase the work RVUs to 1.48. For codes 33234 and 33235, they recommended that no change be made in the work RVUs because both procedures had been recently reviewed by the RUC. *HCFA Proposal:* We have reviewed and propose to accept all of the RUC recommendations for the cardiology codes. 11. Pediatrics *Comment:*
                         The American Academy of Pediatrics (AAP) submitted approximately 40 codes involving several specialty areas and indicated that they believed these services are undervalued, particularly when they are provided to the pediatric population. A few of these codes were also submitted by other specialty groups and are discussed under those areas (codes 29450, 99291, and 99292). The AAP subsequently indicated to the RUC that they were not interested in pursuing the review of the work RVUs for the following codes for this 5-year review: 11100, 11730, 17000, 17003, 17004, 20600, 36600, 52300, 52327, and 52340. *RUC Recommendation:* For codes 36400 and 36405, the RUC agreed that an increase in the work RVUs appeared to be warranted and recommended work RVUs of 0.38 and 0.32, respectively. However, for codes 94640, 99440, 99233, 99273, and 99274, the RUC indicated that compelling evidence was not provided to suggest a recommendation to increase the work RVUs and thus the current RVUs should be maintained for these services. The RUC recommended that the following codes be submitted to the CPT Editorial panel for further consideration: 12001, 12002, 36406, 36520, 50200, 90935, 90937, 90945, 90947, 90989, 90993, 90997, 94664, and 94665. For codes 99295, 99296, 99297, 99298, and 99436, the RUC recommended no change in the work RVUs for these services because these services had recently been reviewed by the RUC. *HCFA Proposal:* We have reviewed and propose to accept all but two of the RUC recommendations for the pediatric codes. For code 36400 
                        *(Venipuncture, under age 3 years; femoral, jugular or sagittal sinus)*, the RUC recommended an increase in work RVUs from 0.18 to 0.38. The RUC survey compared this code to code 36410 
                        *(Drawing blood, child over 3 or adult, necessitating physician's skill (separate procedure), for diagnostic or therapeutic purposes)*
                         (work RVUs of 0.18). The survey times indicated that the pre-, intra-, and postservice times for code 36400 were less than the times for code 36410. The median work RVUs from the survey were 0.71, and the 25th percentile work RVUs were 0.30. The specialty society recommended work RVUs of 0.71, citing the change in population of patients requiring this procedure (being younger and smaller). The RUC also compared code 36400 to code 99212 (Office/outpatient visit, established patient) with work RVUs of 0.45 and believed the work RVUs of code 36400 were comparable to the work RVUs of code 99212). The RUC then recommended work RVUs between the 25th percentile of the survey and the work RVUs of code 99212. We do not believe it is appropriate to compare the work RVUs of a venipuncture to the work of an evaluation and management service. Furthermore, we are concerned about the spread in the survey work RVUs from 0.30 at the 25th percentile to 0.71 at the median. In view of the survey times being less than the reference code (with work RVUs of 0.18), the inconsistency of the survey times with the survey RVUs, and the inappropriate comparison to an evaluation and management service, we are proposing to continue the work RVUs of code 36400 as 0.18 work RVUs. For code 36405 
                        *(Venipuncture, under age 3 years; scalp vein)*, the RUC recommended an increase in work RVUs from 0.18 to 0.32. The survey compared code 36405 to code 36410. The pre-, intra-, and postservice times for code 36405 were less than the times for the reference code. The survey RVUs were widely spread with the 25th percentile work RVUs being 0.2 and the median work RVUs being 0.4. The RUC also compared code 36405 to code 99212 (0.45) and recommended a value between the survey 25th percentile work RVUs and the work RVUs for code 99212. Our concerns about this recommendation are similar to the concerns about the recommendation for code 36400. In view of the survey times, the wide range of survey work RVUs, and the inappropriate comparison to an evaluation and management service, we are proposing to continue the work RVUs of code 36405 at 0.18. 12. Pediatric Surgery *Comment:*
                         The American Pediatric Surgical Association (APSA) stated that the pediatric surgery procedure codes are misvalued and included recommended work RVUs. While they suggested reductions in the work RVUs of codes 46705 and 46715 to retain relativity in the family of services, they believed that the majority of the codes they provide are significantly undervalued. The association justifies the need to increase the work RVUs for these services based on one or more of the following rationales: A change in practice and technology.
                    A change in the patient population for which the code is most frequently applied.
                    An undervaluation of the postservice work in the global period.
                    Rank-order anomalies.
                    Extended postoperative critical care. It is the provision of very intensive, prolonged services with long episodes of critical care and long hospital stays that account for the very high work RVUs recommended for some procedures. APSA subsequently indicated that they did not want to pursue review of two codes under the 5-year review: 43305 and 60280. *RUC Recommendation:* The RUC recommended that the suggested decreases in the work RVUs 
                        ( print page 31064)
                        for codes 46705 and 46715 be implemented. The recommended work RVUs are 6.90 for code 46705 and 7.20 for code 46715. Based on the information provided by the specialty society, the RUC recommended increasing work RVUs for the following codes to address the undervalued physician work in the intra- and postservice periods, the extended critical care services, and a change in patient population: 39503 (95.00); 44055 (22.00); 46716 (15.07); 46730 (26.75); 46735 (32.17); 46740 (30.00); 46742 (35.80); 46744 (52.63); 46746 (58.22); 46748 (64.21); 49215 (33.50); and 49605 (76.00). The RUC did not receive compelling evidence to suggest that an increase is needed in the work RVUs for these codes: 36822, 45120, 45121, 47701, and 49606. The RUC recommended that the following codes be referred to the CPT Editorial Panel for clarification and review: 21740, 43310, 43312, 49495, and 49496. In some instances, new codes may need to be created to accurately value services performed on the pediatric and adult population. *HCFA Proposal:* We propose to accept all but two of the RUC recommendations for the pediatric surgery codes. The RUC recommended large increases in work RVUs for codes 39503 
                        *(Repair, neonatal hernia, with or without chest tube insertion and with or without creation of ventral hernia)*
                         and 49605 
                        *(Repair of large omphalocele or gastrochsis; with or without prosthesis)*
                         for both of these procedures (an increase from 37.54 to 95.0 work RVUs for code 39503 and from 24.94 to 76.0 work RVUs for code 49605). These increases were based entirely on the increase of postoperative work required for these procedures, resulting in an increase of approximately 50 work units for each code. Both procedures are performed on neonates who require prolonged stays in the intensive care unit postoperatively. We understand that the postoperative care may be performed by the surgeon, the intensivist, or both physicians. In situations where the postoperative care is provided by both physicians, we could make duplicate payments for postoperative care if we continue to value these as 90-day global procedures. To permit the physician who is performing the postoperative care to be appropriately paid, but prevent duplicate payment for the same services, we are considering a reduction in the global period (for example, making the global period 10 or 0 days). If we shortened the global period for these services, appropriate work RVUs consistent with this change would need to be developed. If the surgeon provides postoperative care outside of the 10-day global period (that is, 10 days after the date of surgery)or outside of the 0-day global period (that is, the day after surgery) he or she would bill separately for those services. Moreover, if the intensivist provides the postoperative care, then the intensivist would bill for the service, and there would be no duplicate payment to the surgeon. Based on the above discussion, we are proposing to maintain the current RVUs for these two CPT codes (39503 and 49605) as an interim for 2002 and would ask the RUC to submit work RVU recommendations for these codes valued with reduced global periods (a 0-day or 10-day period). We would consider the RUC recommendations and make a proposal to initiate a change to the global period as well as associated RVUs in next year's proposed rule. We invite comments on the issue of reducing the global period for these services and welcome any alternative suggestions that we could consider that address our concerns of eliminating duplicate payment. 13. Radiology *Comment:*
                         The American College of Radiology (ACR) identified three codes that they believe are undervalued. The code 76065, radiologic examination of an infant, is most commonly performed in the situation of alleged child abuse and requires a significant amount of physician work. Additionally, radiologists indicated that the work RVUs for two mammography procedure codes (codes 76090 and 76091) are not reflective of the amount of physician work necessary to perform all the requirements for the government regulated procedures and ACR standards. The level of quality control and quality assurance requirements instituted by the Food and Drug Administration (FDA) and Mammography Quality Standards Act of 1992 (MQSA) have increased the level of physician time outside of the direct patient care time. The current work RVUs assigned to these codes are not adequate to perform this procedure in accordance with Federal regulations or ACR standards. ACR contended the combination of increased mental effort and judgement, psychological stress, time, and intensity mandate that the work RVUs for these codes should be increased. *RUC Recommendation:* The RUC noted that the intensity for code 76065 is higher than the reference service code 76062 and that for intraservice work the physician typically reviews more films. The RUC recommended work RVUs of 0.70 for code 76065. For the mammography procedure codes, the RUC was in agreement that as a result of the revisions of the MQSA requirements, which require the physician to code radiologic results using BIRADs terminology and require that separate reports be sent to the patient and referring physician, the codes result in increased physician time, mental effort, and judgement. In addition, code 76091 is a bilateral mammography requiring two studies to be performed. Based on survey information, the RUC determined the 25th percentile of the survey was the appropriate value and recommended work RVUs of 0.70 for code 76090 and 0.87 for code 76091. *HCFA Proposal:* We have reviewed and propose to accept all of the RUC recommendations for the radiology codes discussed above. We would also note that section 104 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (Public Law 106-554) puts screening mammography under the physician fee schedule for services furnished beginning January 1, 2002. We will include our recommendation of the work RVUs for this service for CY 2002 as part of the physician fee schedule proposed rule for CY 2002. Because this will be a new code in the physician fee schedule, we have asked the RUC to recommend work RVUs for screening mammography. 14. Plastic Surgery *Comment:*
                         The American Society of Plastic Surgery (ASPS) requested that codes 42205 and 49905 be reviewed under the 5-year review. ASPS indicated that there currently is a rank-order anomaly for code 42205 that was created when other codes in the family of codes were reviewed and increased during the first 5-year review. They recommended an increase to the work RVUs (9.59 to 12.0) for this code that would reestablish rank-order in the cleft palate family of codes. With respect to code 49905, ASPS stated that this code is currently designated as an add-on code, which was not the intent of the specialty group when they submitted the proposal to the AMA CPT Editorial Panel in 1991 for creation of this code. They also disagree with our assumption that pre- and postoperative work was included in the RUC-recommended work RVUs that we reduced. ASPA recommended that code 49905 be changed from an add-on to a primary procedure code with a 90-day global period and be assigned work RVUs 
                        ( print page 31065)
                        comparable to those of code 15374 (17.79). *RUC Recommendation:* The RUC reviewed code 42205 and recommended an increase in the work RVUs (for work RVUs of 13.29), which will correct the existing rank-order anomaly in this family of codes. The RUC recommended that code 49905 be referred to the CPT Editorial Panel for review. *HCFA Proposal:* We have reviewed and proposed to accept the RUC recommendations for the plastic surgery codes. C. Other Comments 1. Anesthesia Services The American Society of Anesthesiologists (ASA) contended that the work of anesthesia services is undervalued by almost 31 percent. (This initial request was subsequently adjusted based on additional discussions with the RUC.) As required by law, we base Medicare payments for anesthesia services on allowable base and time units. We have developed a uniform relative value guide in which the base unit per anesthesia code is largely based on the American Society of Anesthesiologists' 1988 relative value guide. Anesthesiologists report the actual anesthesia time for each procedure on the claim, and the carrier converts the time to time units. The carriers then multiply the sum of the base units and time units by the anesthesia conversion factor. We used the results of the original Harvard Study on work to determine the adjustment to the anesthesia CF under the physician fee schedule in 1992. (Anesthesia services do not have work RVUs. Therefore, if work RVUs of other physician services are increased an adjustment has to be made to the anesthesia CF so that the work of anesthesia services remains on the same scale as other physician work.) In the first 5-year review of work, we accepted the RUC's recommendation that the work of anesthesia services was undervalued by 22.76 percent, which resulted in a 16 percent increase in the anesthesia CF. The approach to this 5-year review used by the ASA involves a physician survey and a consensus panel review. The survey was sent to 262 members of the ASA in a geographically representative sample. Eighty-five surveys were returned from respondents who were geographically representative of the specialty as a whole. The findings of the survey were presented to an expert consensus panel of 16 practicing anesthesiologists from the ASA's Relative Value System (RVS) Committee. The work of the anesthesia service was uniformly divided into five components. These components are—preoperative evaluation, equipment and supply preparation, induction period, postinduction anesthesia period, and postoperative care and visits. The survey median times were assigned to each of the five components. The consensus panel assigned the work RVUs of an evaluation and management code, usually codes 99202 or 99201, to the preoperative evaluation. The consensus panel developed a code-specific survey time estimate and intensity value for equipment and supply preparation. For postoperative care and visits, the consensus panel assigned work RVUs equivalent to those of an evaluation and management code, usually code 99211 or 99231. The survey median time for the postinduction anesthesia period was divided in quintiles and each quintile was assigned intensity work RVUs ranging from 0.026 to 0.085. The consensus panel identified the typical anesthetic by procedure code and generally used the intensity of code 31500, 
                        *Intubation, endotracheal, emergency procedure,*
                         a similar CPT code, to value the work. This methodology was used for 19 high-volume surgical codes requiring anesthesia and representing a reasonable variety of surgical services. The following illustrates this approach for anesthesia code 00404 and the underlying surgical code 19240 (Modified radical mastectomy): *Work RVUs*Preanesthesia Median Time
15 min.• Preanesthesia reference code 99202
0.88Equipment and Supply Preparation Median Time
10 min.   0.14Induction Period Procedure Time
10 min.   0.93Post Induction Anesthesia Period:Level 1 Time
87 min.Level 2 Time
10 min.Level 3 Time
10 min.Level 4 Time
0 min.Level 5 Time
0 min.   3.09Postanesthesia Time
14 min.• Postanesthesia Reference Code 99231
0.64Total Work RVUs
5.68
 For each code, the total work RVUs were compared to a Medicare fee schedule imputed work value. The Medicare imputed work value is computed by multiplying the average allowed anesthesia charge per code by the anesthesia work share and dividing by the national CF. The average anesthesia allowed charge is determined by surgical code from HCFA's 5 percent Beneficiary File. Based on this analysis, the ASA requested a 24 percent increase in anesthesia work. *RUC Recommendation:* The RUC furnished no recommendation on anesthesia services; instead it assigned to a newly created workgroup the responsibility for reviewing anesthesia services in the context of the physician fee schedule. The ASA will be working with this workgroup on clinical issues, such as induction and postinduction intensity RVUs. *HCFA Proposal:* We propose to make no changes to the anesthesia CF at this time to reflect the 5-year review of physician work for anesthesia services. However, we may make changes in response to recommendations the RUC may provide. 2. Spine Injection Procedures *Comment:*
                         The American Society of Anesthesiologists submitted a request for re-evaluation of seven spinal injection codes that they, along with several other medical associations, had expressed concern about when the codes were revalued for CY 2000. They continue to believe the work RVUs 
                        ( print page 31066)
                        assigned by the RUC in 1999 and forwarded to HCFA were appropriate. *RUC recommendation:* In 1999, when the RUC forwarded revised work RVUs, we agreed with the relativity of the four injection codes (62310, 62311, 62318, and 62319), but applied a budget-neutrality factor that the specialties believe is inappropriate. In 1999, we also decreased the RUC-recommended work RVUs for codes 72275, 62263, and 76005 based on our belief that the values were too high. The RUC has now reviewed the original surveys and subsequent recommendations and continues to believe that its 1999 recommendations for work RVUs for these codes are appropriate. They recommended the following work RVUs for these services: 62310 (2.20); 62311 (1.78); 62318 (2.35); 62319 (2.15); 62263 (7.20); 72275 (0.83) and 76005 (0.60). (Note: for code 76005, the work RVUs were 0.60 for this service on the CY 2000 fee schedule) *HCFA Proposal:* We propose to reject the RUC recommendations for these codes for the following reasons: Codes 62310 
                        *(Single injection (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic)),*
                         62311 
                        *(Single injection (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodoic, opioid, steroid, other solution), epidural or subarachnoid, lumbar, sacral(caudal)),*
                         62318 
                        *(Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast(for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic), and*
                         62319 
                        *(Injection, including catheter placement, continuous infusion or intermittent bolus, not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodoic, opioid, steroid, other solution), epidural or subarachnoid; lumbar, sacral (caudal)).* These were new codes for CY 2000. The RUC submitted recommendations for these codes in CY 1999. We accepted the RUC recommendations and made a work-neutrality adjustment because these new codes replaced codes under which these services were billed before 2000. The RUC and several specialty societies disagreed with the data we used in making our work-neutrality adjustment. (Work-neutrality adjustments ensure that the recommendations for work RVUs for new and revised services are adjusted so that the sum of the new or revised work RVUs (weighted by projected frequency of use).) for a family of codes will be the same as the sum of the current work RVUs (weighted by frequency of use). We have reviewed the data used to make our work-neutrality adjustment and have determined that the adjustment made was accurate. The RUC work recommendations for the 5-year review are identical to the recommendations we received and evaluated in CY 1999. In view of this, we are proposing to maintain the current work RVUs for these services. Code 62263 
                        *(Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, spring-wound catheter) including radiologic localization (includes contrast when administered).* This was a new code for CY 2000. We received RUC recommendations in CY 1999 for this code and disagreed with them. The RUC recommendation was 7.20 work RVUs, and we made the interim work RVUs 6.02 for CY 2000. In the summer of 2000, we convened a multispecialty review panel that reviewed this code in detail and recommended work RVUs of 6.14. We finalized the multispecialty review panel recommendation of 6.14 work RVUs for CY 2001. The current RUC recommendation is identical to the RUC recommendation from CY 1999. We find no compelling reason to change the RVUs for this procedure, especially since this procedure was reviewed by a multispecialty panel less than 1 year ago. We propose to continue the current work RVUs for this procedure. Code 72275 
                        *(Epidurography, radiological supervision and interpretation).* This code was new for CY 2000. The RUC submitted a recommendation for 0.83 RVUs. We disagreed with this recommendation and made the interim work RVUs 0.54 for CY 2000. We submitted this code to a multispecialty review panel that recommended an increase to 0.76 work RVUs that we implemented for CY 2001. The RUC now submits a recommendation of 0.83 work RVUs for this procedure, identical to its prior recommendation. In the absence of compelling reasons to change the current work RVUs, and because this code was reviewed by an objective multispecialty panel less than 1 year ago, we are proposing to continue the current work RVUs. Additionally, codes 62310, 62311, 62318, 62319, 62263, and 72275 were reviewed and finalized in the July 2000 Multispecialty Refinement Panels for new and/or revised services. Since the RUC recommendations have offered no evidence in addition to that which was presented at the July 2000 Multispecialty Refinement Panel Meeting, we propose to retain the existing work RVUs. 3. Biofeedback *Comment:*
                         One organization, Medcare, requested review of the work and practice expense RVUs for biofeedback codes 90911 and 90901, as it believes that these codes currently are undervalued. *RUC Recommendation:* The RUC reviewed the original survey data for code 90911 and noted that while we had decreased the original RUC-recommended work RVUs, we received no further information to indicate that our rationale for reducing the work RVUs was inappropriate, and the specialty societies that perform the service did not present new information in response to the decrease. The RUC recommended that the current RVUs be maintained since it received no compelling evidence to recommend an increase in work RVUs. *HCPAC Recommendation:* The HCPAC recommended that the current work RVUs be maintained for code 90901 because we received no additional information from the specialists who perform this service to warrant an increase in work RVUs. *HCFA Proposal:* We reviewed and propose to accept the RUC and HCPAC recommendations for biofeedback services. 4. Surgical Management of Burn Wounds *Comment:*
                         The American Burn Association (ABA) submitted codes commonly used for the surgical management of burn wounds (codes 15000 through 15641). The ABA requested assignment of RVUs for these codes that more appropriately reflect the work involved. ABA also requested the creation of more specific codes that would obviate the need for “G” codes. The ABA indicated that these codes should be exempt from CPT payment policies with respect to the 90-day global period, multiple procedures and 
                        ( print page 31067)
                        staged procedures due to the unique clinical case management of burns. *RUC Recommendation:* The RUC recommended that the following codes be reviewed by the CPT Editorial Panel: 15000, 15001, 15100, 15101, 15120, 15121, 15350, 15351, 15400, and 15401. *HCFA Proposal:* We have reviewed and proposed to accept the RUC recommendation for these codes. 5. Transplantation *Comment:*
                         The American Society for Transplant Surgeons requested reassessment of the work RVUs for code 47134 because the current work RVUs do not accurately reflect the work involved (it contended that over 50 percent of these procedures involve right lobectomies that are more labor intensive than left lobectomies, on which the current work RVUs are based). As an alternative, the American Society for Transplant Surgeons also suggested referral to the CPT Editorial Panel for consideration of creation of an additional code. *RUC Recommendation:* The RUC recommended that code 47134 be forwarded to the CPT Editorial Panel for further consideration. *HCFA Proposal:* We have reviewed and propose to accept the RUC recommendation for this code. 6. Arthroscopy Services *Comment:*
                         The Arthroscopy Association of North America (AANA) requested that work for other arthroscopy services be reconsidered in light of the increase in work RVUs for code 29848 in the last 5-year review. The AANA also requested a specific increase in the work RVUs for code 29889. Subsequently, the specialty society chose not to pursue its request for consideration for code 29881. *RUC Recommendations:* For code 29883, the RUC noted that this service consisted of two procedures, medial and lateral meniscus repair. Because this service encompassed the work involved in code 29882 plus additional work for the lateral meniscus repair, and using the building-block approach, the RUC recommended work RVUs of 11.05 for this service. For code 29889, the RUC indicated that, due to the increase in post-and intraservice time, the work RVUs should be increased to 16.00. *HCFA Proposal:* We have reviewed and propose to accept the RUC recommendation for this code. 7. Wheelchair Management *Comment:*
                         The American Physical Therapy Association requested review of code 97542. *HCPAC Proposal:*
                         We had revised the recommended work RVUs for this code when it was previously reviewed by the HCPAC in 1995, based on a comparison of code 97542 to code 97032 rather than to code 97110. The HCPAC concluded that our comparison was incorrect because code 97032 is the application of a modality, while code 97542 requires additional skills because the patients requiring this service have cognitive, sensory, and physical disabilities. In addition, HCPAC indicated that we may not have understood that this procedure is reported very infrequently. The HCPAC supports its original recommendation of 0.45 work RVUs for this service. *HCFA Proposal:* We have reviewed and propose to accept the HCPAC recommendation for this code. 8. Psychological Testing *Comment:*
                         The American Psychological Association recommended that we review five psychological testing codes (96100, 96105, 96110, 96115, and 96117). *HCPAC Recommendation:* The HCPAC did not have any recommendations for these codes at this time. However, it indicated that the American Psychological Association may request HCPAC to review these services at a future date once additional information is collected. *HCFA Proposal:* We propose to make no changes at this time. We believe more precise definitions of these services may be necessary to value them properly and to ensure proper coding and billing of these services. 9. Podiatric Services *Comment:*
                         The American Podiatric Medical Association submitted five codes (trim skin lesions/trim nails) for review (11719, 11055, 11056, 11057, and G0127) indicating that they are undervalued and do not accurately reflect the level of physician work involved. *HCPAC Recommendation:* The HCPAC reviewed these codes and had no information to support an increase in work RVUs. However, the HCPAC requested that we review our current utilization data to ensure that the original utilization assumptions were correct. The HCPAC recommended that the current review of data should be based on actual 1999 utilization data since these codes were not fully implemented until April 1, 1998. *HCFA Proposal:* Taking into account the recommendation of the HCPAC, we propose to review utilization data associated with the aforementioned codes to ensure the original assumptions are still correct. We will publish our final decision in the November 2001 final rule. D. Other Issues 1. Critical Care Services in a Global Period Validation of RUC recommendations for the work of many surgical procedures included the use of a “building-block” methodology as previously described. Before this 5-year review, the RUC compared the work of a postoperative intensive care unit visit by the surgeon to a level three subsequent hospital visit (code 99233) which is valued at 1.51 work RVUs. Now, for the first time since the inception of the physician fee schedule, one of the “building blocks” the RUC used to validate postoperative work by the surgeon in the intensive care unit is code 99291 (
                        *Critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 minutes*), which is valued at 4.00 work RVUs. Specifically, the RUC validated the postoperative work of several thoracic, vascular, and general surgical procedures by comparing the surgeon's intensive care unit visits to code 99291. Current Medicare policy allows separate payment to the surgeon for postoperative critical care services during the surgical global period only when the patient has suffered trauma or burns. If the surgeon provides critical care services during the global period, for reasons unrelated to the surgery, that is separately payable as well. The RUC recommendations have raised several issues for which we are considering future action. In view of our desire to ensure that Medicare beneficiaries have appropriate access to critical care services, and to ensure that we make appropriate payments to physicians furnishing postoperative critical care services to Medicare beneficiaries, we are soliciting information and comments on the following questions and issues: 1. If critical care (as described in CPT 2001) is provided postoperative, who typically provides this care? The surgeon, an intensivist, other physicians? 2. Do surgeons typically meet the CPT requirements for billing critical care services (as described in CPT 2001) 
                        ( print page 31068)
                        when making intensive care unit visits on their postoperative patients? 3. Are surgeons currently performing more, or less, critical care on their postoperative patients than they were at the time of the last 5-year review? 4. What is, or will be, the effect of “closed” intensive care units (a unit staffed by dedicated intensivists who manage the care for all patients in the intensive care unit) on who performs postoperative critical care services? 5. What is the likelihood of making duplicate payment for critical care services if the surgical global period is valued with the inclusion of critical care in the postoperative work (for example, if we also pay an intensivist for postoperative critical care services)? 6. If valuation of the surgical global period includes postoperative critical care, are there concerns about additional carrier scrutiny being applied to claims from intensivists for postoperative critical care services? 7. Does valuation of the surgical global period with the inclusion of postoperative critical care create an incentive for the surgeon to either (a) not perform postoperative critical care services if there is an intensivist available or (b) to not consult an intensivist if one is available? Below are some of the options we are considering: Removing work RVUs for critical care services from the surgical global period, valuing these services as subsequent hospital visits and allowing surgeons to bill separately for critical care (for an identified subset of surgical procedures where there is a high likelihood that the surgeon is typically providing critical care services).
                    Removing the work RVUs for critical care services from the surgical global period, valuing these services as subsequent hospital visits and not allowing surgeons to bill separately for critical care services.
                    Leaving the work RVUs for critical care services in the surgical global period, not allowing surgeons to bill separately for critical care services, requiring surgeons to follow documentation rules for critical care services and instructing carriers to make payment for medically necessary critical care services furnished by other physicians. (This option would facilitate tracking of critical care services, permit appropriate medical record review, and provide a basis to re-evaluate the work of the procedure.) Valuing the surgeon's postoperative intensive care unit visits as critical care services has raised a number of issues. We believe these issues will require a change in payment policy to ensure that postoperative critical care is appropriately paid. Therefore, we are proposing to make the work RVUs for those surgical codes where any postoperative intensive care unit visits were valued as critical care, interim, until we address the issues discussed above. 2. Codes Referred to CPT As discussed in sections B and C above, there were some codes that commenters had submitted for review that the RUC recommended be referred to the CPT Editorial Panel for clarification or consideration of definitional changes. These codes are listed in Table 2, which follows. Table 2.—Codes Referred to CPT Editorial Panel From Five-Year Review of Work Relative Value Units
CPT/HCPCS
                                 
                                    code 1
Mod
Descriptor12001

Repair superficial wound(s)12002

Repair superficial wound(s)15000

Skin graft15001

Skin graft add-on15100

Skin split graft15101

Skin split graft add-on15120

Skin split graft15121

Skin split graft add-on15350

Skin homograft15351

Skin homograft add-on15400

Skin heterograft15401

Skin heterograft add-on20205

Deep muscle biopsy21740

Reconstruction of sternum23076

Removal of shoulder lesion24076

Remove arm/elbow lesion25076

Removal of forearm lesion27048

Remove hip/pelvis lesion27328

Removal of thigh lesion27619

Remove lower leg lesion33875

Thoracic aortic graft33877

Thoracoabdominal graft35381

Rechanneling of artery35541

Artery bypass graft35546

Artery bypass graft35551

Artery bypass graft35582

Vein bypass graft35641

Artery bypass graft35646

Artery bypass graft35840

Explore abdominal vessels35860

Explore limb vessels36406

Drawing blood36520

Plasma and/or cell exchange36533

Insertion of access device36534

Revision of access device36535

Removal of access device36620

Insertion catheter, artery37615

Ligation of neck artery37618

Ligation of extremity artery37700

Revise leg vein37720

Removal of leg vein37730

Removal of leg veins37735

Removal of leg veins/lesion37760

Revision of leg veins37785

Revision secondary varicosity43215

Esophagus endoscopy43310

Repair of esophagus43312

Repair esophagus and fistula47134

Partial removal, donor liver49495

Repair inguinal hernia, init49496

Repair inguinal hernia, init49905

Omental flap50200

Biopsy of kidney50230

Removal of kidney90935

Hemodialysis, one evaluation90937

Hemodialysis, repeated eval90945

Dialysis, one evaluation90947

Dialysis, repeated eval90989

Dialysis training, complete90993

Dialysis training, incompl90997

Hemoperfusion94664

Aerosol or vapor inhalations94665

Aerosol or vapor inhalations
 3. Budget Neutrality Section 1848(c)(2)(B) of the Act requires that increases or decreases in relative value units may not cause the amount of expenditures for the year to differ by more than $20 million from what expenditures would have been in the absence of these changes. If this threshold is exceeded, we make adjustments to preserve budget neutrality. This year, budget-neutrality adjustments will be required for changes in work relative value units resulting from the 5-year refinement. Revisions in payment policies, including the establishment of interim and final relative value units for coding changes that will be announced later this year, may result in additional budget-neutrality adjustments. We considered making the statutorily required budget-neutrality adjustments 
                        ( print page 31069)
                        to account for the 5-year review of physician work by reducing all work RVUs. We estimate that all work RVUs would have to be reduced by 0.7 percent under this option. Alternatively, we considered making an adjustment to the physician fee schedule CF to meet the provisions of section 1848(c)(2)(B). This option would require an estimated 0.3 percent reduction in the conversion factor. For the 5-year review, we are proposing to reduce the conversion factor by 0.3 percent to meet the provisions of section 1848(c)(2)(B). *HCFA Proposal:* We propose to make the budget-neutrality adjustment by reducing the CF. 4. Calculation of Practice Expense and Malpractice Expense RVUs As we noted in the November 2, 1999 final rule (64 FR 59427), practice expense and malpractice expense RVUs were not subject to comment and will not be recalculated (other than the change to practice expense RVUs that result from changes in work) as part of the 5-year review of work RVUs. Section 4505 of the BBA also provides for the gradual 4-year transition for resource-based practice expenses, with resource-based practice expenses becoming fully effective in CY 2002. We are currently in the process of developing our annual physician fee schedule proposed rule that will continue the 4-year refinement process for resource-based practice expense RVUs. Section 4505(f) of the Balanced Budget Act of 1997 (BBA) amended section 1848(c)(2)(C) of the Act and requires us to implement resource-based malpractice RVUs for services furnished beginning in CY 2000. A methodology for establishing resource-based malpractice RVUs was included in the November 1999 final rule and implemented January 1, 2000. In addition, based on concerns expressed by commenters, updated premium data used under this methodology were obtained and used to calculate malpractice RVUs for CY 2001. Since resource-based malpractice RVUs were recently implemented, and resource-based practice expenses are in the final phase of transition to a fully resource-based system, these components are not being included in this 5-year review. However, as stated above we expect to publish our annual physician fee schedule proposed rule that will propose continuing refinements to resource-based practice expense RVUs. 5. Nature and Format of Comments on Work RVUs We will accept comments on the proposed work RVUs for the codes identified in the Addendum of this notice. We will also accept comments on the anesthesia codes. Comments should discuss how the work associated with a given CPT or HCPCS code is analogous to the work in other services or discuss the rationale for disagreeing with the proposed work RVU. We are especially interested in information or arguments that were not presented in earlier comments. III. Collection of Information Requirements This document does not impose information collection and recordkeeping requirements. Consequently it need not be reviewed by the Office of Management and Budget under the authority of the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 
                        *et seq.*) IV. Response to Comments Because of the large number of items of correspondence we normally receive on 
                        **Federal Register**
                         documents published for comment, we are not able to acknowledge or respond to them individually. We will consider all comment received by the date and time specified in the 
                        **DATES**
                         section of this preamble, and we will respond to the comments in the physician fee schedule final rule. V. Regulatory Impact Analysis A. Overall Impact We have examined the impacts of this proposed notice as required by Executive Order 12866 (September 1993, Regulatory Planning and Review) and the Regulatory Flexibility Act (RFA) (September 9, 1980 Public Law 96-354). Executive Order 12866 directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis must be prepared for major rules with economically significant effects ($100 million or more annually). While the changes in the Medicare physician fee schedule due to the 5-year review are budget neutral, they do involve a redistribution of Medicare spending among procedures that will exceed $100 million. For this reason, we are considering this to be a major rule. We estimate that the aggregate amount of payments being redistributed among specialties as a result of the 5-year review will be over $200 million. The RFA requires agencies to analyze options for regulatory relief of small businesses. For purposes of the RFA, small entities include small businesses, nonprofit organizations and government agencies. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of $7.5 million or less annually for physicians and $5 million or less for other practitioners. For purposes of the RFA and based on small business administration data for 1997 we estimate that there are 162,000 physician organizations that meet the definition of a small entity. There are about 700,000 physicians and other practitioners who receive Medicare payment under the physician fee schedule. Individuals and States are not included in the definition of a small entity. In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 603 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a Metropolitan Statistical Area and has fewer than 100 beds. Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule that may result in expenditure in any one year by State, local, or tribal governments, in the aggregate, or by the private sector, of $110 million. We have determined that this rule has no consequential effect on State, local or tribal governments. We believe the private sector costs of this rule will fall below this threshold as well. For purposes of Executive Order 12866 and the RFA, we have prepared the following analysis, which, together with the rest of this preamble, meets all four assessment requirements. It explains the rationale for and purpose of the proposed notice, details the costs and benefits of the proposed notice, analyzes alternatives, and presents the measures we considered to minimize burden on small entities. Section 1848(c)(2)(B) of the Act requires that increases or decreases in RVUs may not cause the amount of expenditures for the year to differ by more than $20 million from what expenditures would have been in the absence of these changes. If this threshold is exceeded, 
                        ( print page 31070)
                        we make adjustments to preserve budget neutrality. This year, budget-neutrality adjustments will be required for changes in work relative value units resulting from the 5-year refinement. Revisions in payment policies, including the establishment of interim and final relative value units for coding changes that will be announced later this year, may result in additional budget-neutrality adjustments. We considered making the statutorily required budget-neutrality adjustments to account for the 5-year review of physician work by reducing all work RVUs. We estimate that all work RVUs would have to be reduced by 0.7 percent under this option. Alternatively, we considered making an adjustment to the physician fee schedule CF to meet the provisions of section 1848(c)(2)(B) of the Act. This option would require an estimated 0.3 percent reduction in the CF. For the 5-year review, we are proposing to reduce the CF by 0.3 percent to meet the provisions of section 1848(c)(2)(B) of the Act. Table 3.—Percent Change in Total Payments by Specialty Resulting From the 5 Year Review of Work
Specialty
Allowed charges
                                 (billions)
Percent change in total payments from increase in work
Percent change in total payments from change in PE
Total percent change in payments from 5 year reviewAnesthesiology
1.5
1
0
1Cardiac Surgery
0.3
5
1
6Cardiology
4.2
0
−1
−1Chiropractor
0.4
0
0
0Clinics
1.6
0
0
0Dermatology
1.4
0
0
0Emergency Medicine
1.0
0
0
0Family Practice
3.3
0
0
0Gastroenterology
1.2
0
0
0General Practice
1.0
0
0
0General Surgery
2.0
3
1
4Hematology Oncology
0.6
0
−1
−1Internal Medicine
7.1
0
0
0Nephrology
1.0
0
0
0Neurology
0.9
0
0
0Neurosurgery
0.4
0
0
0Nonphysician Practitioner
1.2
0
0
0Obstetrics/Gynecology
0.4
0
0
0Ophthalmology
3.9
0
0
0Optometrist
0.5
0
0
0Orthopedic Surgery
2.3
0
0
0Other Physician
1.6
0
0
0Otolaryngology
0.6
0
0
0Pathology
0.6
0
0
0Plastic Surgery
0.2
0
0
0Podiatry
1.1
0
0
0Psychiatry
1.1
0
0
0Pulmonary
1.1
0
0
0Radiation Oncology
0.7
0
−1
−1Radiology
3.3
0
−1
−1Rheumatology
0.3
0
0
0Suppliers
0.5
0
0
−1Thoracic Surgery
0.5
4
1
5Urology
1.3
0
0
0Vascular Surgery
0.3
2
0
2**Note:**
                             This table incorporates two separate budget neutrality adjustments. The increase in practice expense relative value units is incorporated through a rescaling of all practice expense RVUs. In addition, all physician fee schedule payments (not the work RVUs) are reduced to make the increase in physician work RVUs budget neutral.
 The table above shows the specialty level payment impact of changes in work and practice expense relative values resulting from the 5-year review. The table includes the effect of budget-neutrality adjustments applied to the physician fee schedule CF. Since the practice expense RVUs are based, in part, on physician work, the table also reflects changes in practice expense RVUs that will result from the 5-year review of physician work. The changes in practice expense RVUs resulting from the changes in physician work RVUs were made budget neutral by rescaling all practice expense RVUs. This table shows the impact on payments per service at the specialty level that would result only from the 5-year review of physician work RVUs. We are in the process of developing our annual physician fee schedule proposed rule that will make refinements in practice expense RVUs and other policies that will affect payment for physician fee schedule services in CY 2002. As part of the physician fee schedule proposed rule, we expect to use revised physician times submitted to us by the RUC in the methodology for determining practice expense RVUs. The RUC is recommending that we use new time data for codes in which they recommended a change in work RVUs. In addition, the RUC is recommending a revision of the time data for many other codes. For some specialties, we expect that use of the revised times will change the impacts shown here. In particular, it appears that the revised times submitted to us by the 
                        ( print page 31071)
                        RUC are less than the times included in our database for many heart and chest procedures. Our expectation is that use of the RUC recommended times will result in a reduction in the practice expense RVUs for these services that are predominantly performed by cardiac and thoracic surgeons. This means that our expectation is that the total payment increase shown here for these specialties will be less when the revised times are used to determine the practice expense RVUs. In addition, there may be other refinements to the practice expense RVUs or other changes in policies that may result in a specialty level payment impact for 2002 that we will announce in our proposed rule. We will show the combined payment impact by specialty, as a result of the revised times and other proposed policy changes, in our notice of proposed rulemaking that we expect to be published shortly. We will show the combined impact of all policy changes affecting physician fee schedule payments in 2002 in one final rule that we expect to be published no later than November 1, 2001. *Federalism:*Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on State and local governments, preempts State law, or otherwise has Federalism implications. We have determined that this rule will not impose substantial direct requirement costs on State and local governments, preempt State law, or otherwise have Federalism implications. In accordance with the provisions of Executive Order 12866, this regulation was reviewed by the Office of Management and Budget. (42 U.S.C. 1395k(a)(2)(F) and 1395l(i)(1) and (2)); 42 CFR 416.120, 416.125, and 416.130) (Catalog of Federal Domestic Assistance Programs No. 93.774, Medicare—Supplementary Medical Insurance Program) Dated: April 17, 2001. Michael McMullan, Acting Deputy Administrator, Health Care Financing Administration. Dated: April 23, 2001. Tommy G. Thompson, Secretary.
 1 
 
 Addendum—Codes Subject to Comment
CPT/HCPCS 
                                 
                                    code 1
Mod
Descriptor
Proposed 
                                 work RVUG0127

Trim nail(s)
0.1111055

Trim skin lesion
0.2711056

Trim skin lesion, 2 to 4
0.3911057

Trim skin lesions, over 4
0.5011402

Removal of skin lesion
1.6111642

Removal of skin lesion
2.9311642

Removal of skin lesion
2.9311719

Trim nail(s)
0.1112001

Repair superficial wound(s)
1.7012002

Repair superficial wound(s)
1.8612011

Repair superficial wound(s)
1.7613101

Repair of wound or lesion
3.9213131

Repair of wound or lesion
3.7913132

Repair of wound or lesion
5.9515000

Skin graft
4.0015001

Skin graft add-on
1.0015100

Skin split graft
9.0515101

Skin split graft add-on
1.7215120

Skin split graft
9.8315121

Skin split graft add-on
2.6715350

Skin homograft
4.0015351

Skin homograft add-on
1.0015400

Skin heterograft
4.0015401

Skin heterograft add-on
1.0019000

Drainage of breast lesion
0.8419100

Biopsy of breast
1.2719125

Excision, breast lesion
6.0619160

Removal of breast tissue
5.9919162

Remove breast tissue, nodes
13.5319240

Removal of breast
16.0020205

Deep muscle biopsy
2.3520245

Bone biopsy, excisional
7.7821740

Reconstruction of sternum
16.5021800

Treatment of rib fracture
0.9623076

Removal of shoulder lesion
7.6323472

Reconstruct shoulder joint
21.1023485

Revision of collar bone
13.4323585

Treat scapula fracture
8.9623615

Treat humerus fracture
9.3523630

Treat humerus fracture
7.3523680

Treat dislocation/fracture
10.0624076

Remove arm/elbow lesion
6.3024435

Repair humerus with graft
13.17( print page 31072)24545

Treat humerus fracture
10.4625076

Removal of forearm lesion
4.9226562

Repair of web finger
15.0027048

Remove hip/pelvis lesion
6.2527075

Extensive hip surgery
35.0027077

Extensive hip surgery
40.0027216

Treat pelvic ring fracture
15.1927217

Treat pelvic ring fracture
14.1127218

Treat pelvic ring fracture
20.1527226

Treat hip wall fracture
14.9127236

Treat thigh fracture
15.6027280

Fusion of sacroiliac joint
13.3927282

Fusion of pubic bones
11.3427284

Fusion of hip joint
23.4527328

Removal of thigh lesion
5.5727472

Repair/graft of thigh
17.7227513

Treatment of thigh fracture
17.9227536

Treat knee fracture
15.6527590

Amputate leg at thigh
12.0327619

Remove lower leg lesion
8.4027724

Repair/graft of tibia
18.2027822

Treatment of ankle fracture
11.0027823

Treatment of ankle fracture
13.0027828

Treat lower leg fracture
16.2328299

Correction of bunion
9.1828322

Repair of metatarsals
8.3428420

Treat/graft heel fracture
16.6428445

Treat ankle fracture
15.6228705

Fusion of foot bones
18.8029450

Application of leg cast
2.0829450

Application of leg cast
2.0829883

Knee arthroscopy/surgery
11.0529889

Knee arthroscopy/surgery
16.0029889

Knee arthroscopy/surgery
16.0031600

Incision of windpipe
7.1831622

Dx bronchoscope/wash
2.7831622

Dx bronchoscope/wash
2.7831625

Bronchoscopy with biopsy
3.3731645

Bronchoscopy, clear airways
3.1632000

Drainage of chest
1.5432000

Drainage of chest
1.5432005

Treat lung lining chemically
2.1932020

Insertion of chest tube
3.9832035

Exploration of chest
8.6732095

Biopsy through chest wall
8.3632100

Exploration/biopsy of chest
15.2432110

Explore/repair chest
23.0032220

Release of lung
24.0032225

Partial release of lung
13.9632320

Free/remove chest lining
24.0032440

Removal of lung
25.0032440

Removal of lung
25.0032480

Partial removal of lung
23.7532480

Partial removal of lung
23.7532482

Bilobectomy
25.0032491

Lung volume reduction
21.2532500

Partial removal of lung
22.0032520

Remove lung & revise chest
21.6832602

Thoracoscopy, diagnostic
5.9632651

Thoracoscopy, surgical
12.9132652

Thoracoscopy, surgical
18.6632655

Thoracoscopy, surgical
13.1032657

Thoracoscopy, surgical
13.6533234

Removal of pacemaker system
7.8233235

Removal of pacemaker electrode
9.4033400

Repair of aortic valve
28.50( print page 31073)33405

Replacement of aortic valve
35.0033406

Replacement of aortic valve
37.5033410

Replacement of aortic valve
32.4633411

Replacement of aortic valve
36.2533412

Replacement of aortic valve
42.0033413

Replacement of aortic valve
43.5033415

Revision, subvalvular tissue
27.1533425

Repair of mitral valve
27.0033426

Repair of mitral valve
33.0033427

Repair of mitral valve
40.0033430

Replacement of mitral valve
33.5033468

Revision of tricuspid valve
30.1233475

Replacement, pulmonary valve
33.0033506

Repair artery, translocation
35.5033510

CABG, vein, single
29.0033511

CABG, vein, two
30.0033512

CABG, vein, three
31.8033513

CABG, vein, four
32.0033514

CABG, vein, five
32.7533516

Cabg, vein, six or more
35.0033517

CABG, artery-vein, single
2.5733518

CABG, artery-vein, two
4.8533519

CABG, artery-vein, three
7.1233521

CABG, artery-vein, four
9.4033522

CABG, artery-vein, five
11.6733523

Cabg, art-vein, six or more
13.9533530

Coronary artery, bypass/reop
5.8633533

CABG, arterial, single
30.0033534

CABG, arterial, two
32.2033535

CABG, arterial, three
34.5033536

Cabg, arterial, four or more
37.5033611

Repair double ventricle
34.0033612

Repair double ventricle
35.0033615

Repair, simple fontan
34.0033617

Repair, modified fontan
37.0033619

Repair single ventricle
45.0033641

Repair heart septum defect
21.3933660

Repair of heart defects
30.0033670

Repair of heart chambers
35.0033681

Repair heart septum defect
30.6133694

Repair of heart defects
34.0033697

Repair of heart defects
36.0033730

Repair heart-vein defect(s)
34.2533750

Major vessel shunt
21.4133767

Major vessel shunt
24.5033770

Repair great vessels defect
37.0033778

Repair great vessels defect
40.0033780

Repair great vessels defect
41.7533786

Repair arterial trunk
39.0033820

Revise major vessel
16.2933840

Remove aorta constriction
20.6333860

Ascending aortic graft
38.0033861

Ascending aortic graft
42.0033863

Ascending aortic graft
45.0033870

Transverse aortic arch graft
44.0033875

Thoracic aortic graft
33.0633877

Thoracoabdominal graft
42.6033917

Repair pulmonary artery
24.5033919

Repair pulmonary atresia
40.0033945

Transplantation of heart
42.1034101

Removal of artery clot
10.0034111

Removal of arm artery clot
10.0034151

Removal of artery clot
25.0034151

Removal of artery clot
25.0034201

Removal of artery clot
10.0334201

Removal of artery clot
10.03( print page 31074)34203

Removal of leg artery clot
16.5034203

Removal of leg artery clot
16.5034401

Removal of vein clot
25.0034401

Removal of vein clot
25.0034421

Removal of vein clot
12.0034421

Removal of vein clot
12.0034451

Removal of vein clot
27.0034451

Removal of vein clot
27.0034490

Removal of vein clot
9.8634501

Repair valve, femoral vein
16.0034510

Transposition of vein valve
18.9534520

Cross-over vein graft
17.9534530

Leg vein fusion
16.6435011

Repair defect of artery
18.0035011

Repair defect of artery
18.0035013

Repair artery rupture, arm
22.0035013

Repair artery rupture, arm
22.0035045

Repair defect of arm artery
17.5735045

Repair defect of arm artery
17.5735081

Repair defect of artery
28.0135082

Repair artery rupture, aorta
38.5035082

Repair artery rupture, aorta
38.5035092

Repair artery rupture, aorta
45.0035092

Repair artery rupture, aorta
45.0035103

Repair artery rupture, groin
40.5035103

Repair artery rupture, groin
40.5035111

Repair defect of artery
25.0035111

Repair defect of artery
25.0035112

Repair artery rupture, spleen
30.0035112

Repair artery rupture, spleen
30.0035121

Repair defect of artery
30.0035121

Repair defect of artery
30.0035122

Repair artery rupture, belly
35.0035122

Repair artery rupture, belly
35.0035131

Repair defect of artery
25.0035131

Repair defect of artery
25.0035132

Repair artery rupture, groin
30.0035132

Repair artery rupture, groin
30.0035141

Repair defect of artery
20.0035141

Repair defect of artery
20.0035142

Repair artery rupture, thigh
23.3035142

Repair artery rupture, thigh
23.3035151

Repair defect of artery
22.6435151

Repair defect of artery
22.6435152

Repair artery rupture, knee
25.6235152

Repair artery rupture, knee
25.6235182

Repair blood vessel lesion
30.0035184

Repair blood vessel lesion
18.0035189

Repair blood vessel lesion
28.0035190

Repair blood vessel lesion
12.7535201

Repair blood vessel lesion
16.1435201

Repair blood vessel lesion
16.1435206

Repair blood vessel lesion
13.2535221

Repair blood vessel lesion
24.3935221

Repair blood vessel lesion
24.3935226

Repair blood vessel lesion
14.5035226

Repair blood vessel lesion
14.5035231

Repair blood vessel lesion
20.0035231

Repair blood vessel lesion
20.0035236

Repair blood vessel lesion
17.1135236

Repair blood vessel lesion
17.1135246

Repair blood vessel lesion
26.4535246

Repair blood vessel lesion
26.4535251

Repair blood vessel lesion
30.2035251

Repair blood vessel lesion
30.2035256

Repair blood vessel lesion
18.36( print page 31075)35261

Repair blood vessel lesion
17.8035261

Repair blood vessel lesion
17.8035266

Repair blood vessel lesion
14.9135266

Repair blood vessel lesion
14.9135276

Repair blood vessel lesion
24.2535276

Repair blood vessel lesion
24.2535281

Repair blood vessel lesion
28.0035281

Repair blood vessel lesion
28.0035286

Repair blood vessel lesion
16.1635311

Rechanneling of artery
27.0035311

Rechanneling of artery
27.0035321

Rechanneling of artery
16.0035321

Rechanneling of artery
16.0035331

Rechanneling of artery
26.2035331

Rechanneling of artery
26.2035351

Rechanneling of artery
23.0035351

Rechanneling of artery
23.0035355

Rechanneling of artery
18.5035355

Rechanneling of artery
18.5035361

Rechanneling of artery
28.2035361

Rechanneling of artery
28.2035363

Rechanneling of artery
30.2035363

Rechanneling of artery
30.2035371

Rechanneling of artery
14.7235371

Rechanneling of artery
14.7235372

Rechanneling of artery
18.0035372

Rechanneling of artery
18.0035381

Rechanneling of artery
15.8135511

Artery bypass graft
21.2035511

Artery bypass graft
21.2035518

Artery bypass graft
21.2035518

Artery bypass graft
21.2035521

Artery bypass graft
22.2035521

Artery bypass graft
22.2035526

Artery bypass graft
29.9535526

Artery bypass graft
29.9535531

Artery bypass graft
36.2035531

Artery bypass graft
36.2035533

Artery bypass graft
28.0035533

Artery bypass graft
28.0035536

Artery bypass graft
31.7035536

Artery bypass graft
31.7035541

Artery bypass graft
25.8035546

Artery bypass graft
25.5435551

Artery bypass graft
26.6735556

Artery bypass graft
21.7635556

Artery bypass graft
21.7635558

Artery bypass graft
21.2035558

Artery bypass graft
21.2035560

Artery bypass graft
32.0035560

Artery bypass graft
32.0035563

Artery bypass graft
24.2035563

Artery bypass graft
24.2035565

Artery bypass graft
23.2035565

Artery bypass graft
23.2035571

Artery bypass graft
24.0635571

Artery bypass graft
24.0635582

Vein bypass graft
27.1335587

Vein bypass graft
24.7535587

Vein bypass graft
24.7535621

Artery bypass graft
20.0035621

Artery bypass graft
20.0035623

Bypass graft, not vein
24.0035623

Bypass graft, not vein
24.0035626

Artery bypass graft
27.7535626

Artery bypass graft
27.75( print page 31076)35631

Artery bypass graft
34.0035631

Artery bypass graft
34.0035636

Artery bypass graft
29.5035636

Artery bypass graft
29.5035641

Artery bypass graft
24.5735646

Artery bypass graft
25.8135650

Artery bypass graft
19.0035650

Artery bypass graft
19.0035654

Artery bypass graft
25.0035654

Artery bypass graft
25.0035661

Artery bypass graft
19.0035661

Artery bypass graft
19.0035663

Artery bypass graft
22.0035663

Artery bypass graft
22.0035665

Artery bypass graft
21.0035665

Artery bypass graft
21.0035666

Artery bypass graft
22.1935666

Artery bypass graft
22.1935671

Artery bypass graft
19.3335671

Artery bypass graft
19.3335701

Exploration, carotid artery
8.5035701

Exploration, carotid artery
8.5035721

Exploration, femoral artery
7.1835741

Exploration popliteal artery
8.0035840

Explore abdominal vessels
9.7735860

Explore limb vessels
5.5535905

Excision, graft, thorax
31.2535905

Excision, graft, thorax
31.2535907

Excision, graft, abdomen
35.0035907

Excision, graft, abdomen
35.0036400

Drawing blood
0.1836405

Drawing blood
0.1836406

Drawing blood
0.1836489

Insertion of catheter, vein
2.5036489

Insertion of catheter, vein
2.5036520

Plasma and/or cell exchange
1.7436533

Insertion of access device
5.3236534

Revision of access device
2.8036535

Removal of access device
2.2736620

Insertion catheter, artery
1.1536625

Insertion catheter, artery
2.1136822

Insertion of cannula(s)
5.4237565

Ligation of neck vein
10.8837565

Ligation of neck vein
10.8837600

Ligation of neck artery
11.2537600

Ligation of neck artery
11.2537605

Ligation of neck artery
13.1137605

Ligation of neck artery
13.1137609

Temporal artery procedure
3.0037609

Temporal artery procedure
3.0037615

Ligation of neck artery
5.7337615

Ligation of neck artery
5.7337617

Ligation of abdomen artery
22.0637618

Ligation of extremity artery
4.8437650

Revision of major vein
7.8037660

Revision of major vein
21.0037700

Revise leg vein
3.7337720

Removal of leg vein
5.6637730

Removal of leg veins
7.3337735

Removal of leg veins/lesion
10.5337760

Revision of leg veins
10.4737785

Revision secondary varicosity
3.8438100

Removal of spleen, total
14.5038100

Removal of spleen, total
14.5038101

Removal of spleen, partial
15.3138115

Repair of ruptured spleen
15.82( print page 31077)38300

Drainage, lymph node lesion
1.9938305

Drainage, lymph node lesion
6.0038308

Incision of lymph channels
6.4538500

Biopsy/removal, lymph nodes
3.7538500

Biopsy/removal, lymph nodes
3.7538510

Biopsy/removal, lymph nodes
6.4338520

Biopsy/removal, lymph nodes
6.6738525

Biopsy/removal, lymph nodes
6.0738530

Biopsy/removal, lymph nodes
7.9838571

Laparoscopy, lymphadenectomy
12.3838572

Laparoscopy, lymphadenectomy
16.5938740

Remove armpit lymph nodes
10.0238745

Remove armpit lymph nodes
13.0038746

Remove thoracic lymph nodes
4.8938760

Remove groin lymph nodes
12.9438765

Remove groin lymph nodes
19.9838780

Remove abdomen lymph nodes
16.5939010

Exploration of chest
11.7939220

Removal chest lesion
17.4239400

Visualization of chest
5.6139503

Repair of diaphragm hernia
34.8542205

Reconstruct cleft palate
13.2943107

Removal of esophagus
40.0043112

Removal of esophagus
43.5043117

Partial removal of esophagus
40.0043122

Parital removal of esophagus
40.0043215

Esophagus endoscopy
2.6043217

Esophagus endoscopy
2.9043219

Esophagus endoscopy
2.8043228

Esoph endoscopy, ablation
3.7743239

Upper GI endoscopy, biopsy
2.6943239

Upper GI endoscopy, biopsy
2.8743244

Upper GI endoscopy/ligation
4.5943246

Place gastrostomy tube
4.3343246

Place gastrostomy tube
4.3343247

Operative upper GI endoscopy
3.3943249

Esoph endoscopy, dilation
2.9043251

Operative upper GI endoscopy
3.7043255

Operative upper GI endoscopy
4.4043258

Operative upper GI endoscopy
4.5543259

Endoscopic ultrasound exam
4.8943263

Endo cholangiopancreatograph
6.1943265

Endo cholangiopancreatograph
8.9043269

Endo cholangiopancreatograph
6.0443310

Repair of esophagus
25.3943312

Repair esophagus and fistula
28.4243320

Fuse esophagus & stomach
19.9343324

Revise esophagus & stomach
20.5743325

Revise esophagus & stomach
20.0643326

Revise esophagus & stomach
19.7443330

Repair of esophagus
19.7743331

Repair of esophagus
20.1343340

Fuse esophagus & intestine
19.6143341

Fuse esophagus & intestine
20.8543350

Surgical opening, esophagus
15.7843351

Surgical opening, esophagus
18.3543352

Surgical opening, esophagus
15.2643360

Gastrointestinal repair
35.7043361

Gastrointestinal repair
40.5043400

Ligate esophagus veins
21.2043401

Esophagus surgery for veins
22.0943405

Ligate/staple esophagus
20.0143410

Repair esophagus wound
13.4743415

Repair esophagus wound
25.0043420

Repair esophagus opening
14.3543425

Repair esophagus opening
21.03( print page 31078)43500

Surgical opening of stomach
11.0543501

Surgical repair of stomach
20.0443502

Surgical repair of stomach
23.1343510

Surgical opening of stomach
13.0843520

Incision of pyloric muscle
9.9943605

Biopsy of stomach
11.9843610

Excision of stomach lesion
14.6043611

Excision of stomach lesion
17.8443620

Removal of stomach
30.0443621

Removal of stomach
30.7343622

Removal of stomach
32.5343631

Removal of stomach, partial
22.5943632

Removal of stomach, partial
22.5943633

Removal of stomach, partial
23.1043634

Removal of stomach, partial
25.1243638

Removal of stomach, partial
29.0043638

Removal of stomach, partial
29.0043639

Removal of stomach, partial
29.6543640

Vagotomy & pylorus repair
17.0243641

Vagotomy & pylorus repair
17.2743651

Laparoscopy, vagus nerve
10.1543652

Laparoscopy, vagus nerve
12.1543800

Reconstruction of pylorus
13.6943810

Fusion of stomach and bowel
14.6543820

Fusion of stomach and bowel
15.3743825

Fusion of stomach and bowel
19.2243830

Place gastrostomy tube
9.5343832

Place gastrostomy tube
15.6043840

Repair of stomach lesion
15.5643842

Gastroplasty for obesity
18.4743843

Gastroplasty for obesity
18.6543846

Gastric bypass for obesity
24.0543847

Gastric bypass for obesity
26.9243848

Revision gastroplasty
29.3943850

Revise stomach-bowel fusion
24.7243855

Revise stomach-bowel fusion
26.1643860

Revise stomach-bowel fusion
25.0043865

Revise stomach-bowel fusion
26.5243870

Repair stomach opening
9.6943880

Repair stomach-bowel fistula
24.6544005

Freeing of bowel adhesion
16.2344010

Incision of small bowel
12.5244020

Exploration of small bowel
13.9944021

Decompress small bowel
14.0844025

Incision of large bowel
14.2844050

Reduce bowel obstruction
14.0344050

Reduce bowel obstruction
14.0344055

Correct malrotation of bowel
22.0044110

Excision of bowel lesion(s)
11.8144111

Excision of bowel lesion(s)
14.2944120

Removal of small intestine
17.0044125

Removal of small intestine
17.5444130

Bowel to bowel fusion
14.4944130

Bowel to bowel fusion
14.4944140

Partial removal of colon
21.0044140

Partial removal of colon
21.0044143

Partial removal of colon
22.9944144

Partial removal of colon
21.5344144

Partial removal of colon
21.5344145

Partial removal of colon
26.4244146

Partial removal of colon
27.5444147

Partial removal of colon
20.7144150

Removal of colon
23.9544151

Removal of colon/ileostomy
26.8844151

Removal of colon/ileostomy
26.8844152

Removal of colon/ileostomy
27.83( print page 31079)44153

Removal of colon/ileostomy
30.5944155

Removal of colon/ileostomy
27.8644156

Removal of colon/ileostomy
30.7944156

Removal of colon/ileostomy
30.7944160

Removal of colon
18.6244200

Laparoscopy, enterolysis
14.4444300

Open bowel to skin
12.1144310

Ileostomy/jejunostomy
15.9544312

Revision of ileostomy
8.0244314

Revision of ileostomy
15.0544316

Devise bowel pouch
21.0944320

Colostomy
17.6444340

Revision of colostomy
7.7244345

Revision of colostomy
15.4344346

Revision of colostomy
16.9944388

Colon endoscopy
2.8244389

Colonoscopy with biopsy
3.1344390

Colonoscopy for foreign body
3.8344391

Colonoscopy for bleeding
4.3244392

Colonoscopy and polypectomy
3.8244393

Colonoscopy, lesion removal
4.8444394

Colonoscopy w/snare
4.4344394

Colonoscopy w/snare
4.4344602

Suture, small intestine
16.0344603

Suture, small intestine
18.6644604

Suture, large intestine
16.0344605

Repair of bowel lesion
19.5344615

Intestinal stricturoplasty
15.9344620

Repair bowel opening
12.2044625

Repair bowel opening
15.0544626

Repair bowel opening
25.3644640

Repair bowel-skin fistula
21.6544650

Repair bowel fistula
22.5744660

Repair bowel-bladder fistula
21.3644661

Repair bowel-bladder fistula
24.8144680

Surgical revision, intestine
15.4044700

Suspend bowel w/prosthesis
16.1144800

Excision of bowel pouch
11.2344820

Excision of mesentery lesion
12.0944850

Repair of mesentery
10.7444900

Drain app abscess, open
10.1444950

Appendectomy
10.0044960

Appendectomy
12.3444970

Laparoscopy, appendectomy
8.7045000

Drainage of pelvic abscess
4.5245020

Drainage of rectal abscess
4.7245100

Biopsy of rectum
3.6845108

Removal of anorectal lesion
4.7645110

Removal of rectum
28.0045111

Partial removal of rectum
16.4845112

Removal of rectum
30.5445113

Partial proctectomy
30.5845114

Partial removal of rectum
27.3245116

Partial removal of rectum
24.5845119

Remove rectum w/reservoir
30.8445120

Removal of rectum
24.6045121

Removal of rectum and colon
27.0445123

Partial proctectomy
16.7145126

Pelvic exenteration
45.1645130

Excision of rectal prolapse
16.4445135

Excision of rectal prolapse
19.2845160

Excision of rectal lesion
15.3245170

Excision of rectal lesion
11.4945190

Destruction, rectal tumor
9.7445305

Proctosigmoidoscopy & biopsy
1.0145309

Proctosigmoidoscopy
2.01( print page 31080)45330

Diagnostic sigmoidoscopy
0.9645337

Sigmoidoscopy & decompress
2.3645339

Sigmoidoscopy
3.1445378

Diagnostic colonoscopy
3.7045380

Colonoscopy and biopsy
4.0145383

Lesion removal colonoscopy
5.8745384

Colonoscopy
4.7045385

Lesion removal colonoscopy
5.3145505

Repair of rectum
7.5845540

Correct rectal prolapse
16.2745541

Correct rectal prolapse
13.4045550

Repair rectum/remove sigmoid
23.0045560

Repair of rectocele
10.5845562

Exploration/repair of rectum
15.3845563

Exploration/repair of rectum
23.4745800

Repair rect/bladder fistula
17.7745805

Repair fistula w/colostomy
20.7845820

Repair rectourethral fistula
18.4845825

Repair fistula w/colostomy
21.2545900

Reduction of rectal prolapse
2.6145905

Dilation of anal sphincter
2.3045910

Dilation of rectal narrowing
2.8045910

Dilation of rectal narrowing
2.8045915

Remove rectal obstruction
3.1446040

Incision of rectal abscess
4.9646045

Incision of rectal abscess
4.3246060

Incision of rectal abscess
5.6946083

Incise external hemorrhoid
1.4046083

Incise external hemorrhoid
1.4046221

Ligation of hemorrhoid(s)
2.0446230

Removal of anal tabs
2.5746250

Hemorrhoidectomy
3.8946255

Hemorrhoidectomy
4.6046257

Remove hemorrhoids & fissure
5.4046258

Remove hemorrhoids & fistula
5.7346258

Remove hemorrhoids & fistula
5.7346260

Hemorrhoidectomy
6.3746261

Remove hemorrhoids & fissure
7.0846262

Remove hemorrhoids & fistula
7.5046270

Removal of anal fistula
3.7246275

Removal of anal fistula
4.5646280

Removal of anal fistula
5.9846288

Repair anal fistula
7.1346320

Removal of hemorrhoid clot
1.6146320

Removal of hemorrhoid clot
1.6146700

Repair of anal stricture
9.1346705

Repair of anal stricture
6.9046715

Repair of anovaginal fistula
7.2046716

Repair of anovaginal fistula
15.0746730

Construction of absent anus
26.7546735

Construction of absent anus
32.1746740

Construction of absent anus
30.0046742

Repair of imperforated anus
35.8046744

Repair of cloacal anomaly
52.6346746

Repair of cloacal anomaly
58.2246748

Repair of cloacal anomaly
64.2146750

Repair of anal sphincter
10.2546753

Reconstruction of anus
8.2946754

Removal of suture from anus
2.2046760

Repair of anal sphincter
14.4346761

Repair of anal sphincter
13.8446762

Implant artificial sphincter
12.7146900

Destruction, anal lesion(s)
1.9146910

Destruction, anal lesion(s)
1.8646916

Cryosurgery, anal lesion(s)
1.8646917

Laser surgery, anal lesions
1.86( print page 31081)46922

Excision of anal lesion(s)
1.8646924

Destruction, anal lesion(s)
2.7646924

Destruction, anal lesion(s)
2.7646934

Destruction of hemorrhoids
3.5146935

Destruction of hemorrhoids
2.4346936

Destruction of hemorrhoids
3.6946940

Treatment of anal fissure
2.3246942

Treatment of anal fissure
2.0446945

Ligation of hemorrhoids
1.8446946

Ligation of hemorrhoids
2.5847010

Open drainage, liver lesion
16.0147015

Inject/aspirate liver cyst
15.1147100

Wedge biopsy of liver
11.6747120

Partial removal of liver
35.5047122

Extensive removal of liver
55.1347125

Partial removal of liver
49.1947130

Partial removal of liver
53.3547134

Partial removal, donor liver
39.1547300

Surgery for liver lesion
15.0847350

Repair liver wound
19.5647360

Repair liver wound
26.9247361

Repair liver wound
47.1247362

Repair liver wound
18.5147400

Incision of liver duct
32.4947420

Incision of bile duct
19.8847425

Incision of bile duct
19.8347460

Incise bile duct sphincter
18.0447480

Incision of gallbladder
10.8247562

Laparoscopic cholecystectomy
11.0947563

Laparoscopic cholecystectomy
11.9447564

Laparo cholecystectomy/explr
14.2347570

Laparo cholecystoenterostomy
12.5847600

Removal of gallbladder
13.5847605

Removal of gallbladder
14.6947610

Removal of gallbladder
18.8247612

Removal of gallbladder
18.7847620

Removal of gallbladder
20.6447701

Bile duct revision
27.8147711

Excision of bile duct tumor
23.0347712

Excision of bile duct tumor
30.2447715

Excision of bile duct cyst
18.8047716

Fusion of bile duct cyst
16.4447720

Fuse gallbladder & bowel
15.9147721

Fuse upper gi structures
19.1247740

Fuse gallbladder & bowel
18.4847741

Fuse gallbladder & bowel
21.3447760

Fuse bile ducts and bowel
25.8547765

Fuse liver ducts & bowel
24.8847780

Fuse bile ducts and bowel
26.5047785

Fuse bile ducts and bowel
31.1847800

Reconstruction of bile ducts
23.3047801

Placement, bile duct support
15.1747802

Fuse liver duct & intestine
21.5547900

Suture bile duct injury
19.9048000

Drainage of abdomen
28.0748001

Placement of drain, pancreas
35.4548005

Resect/debride pancreas
42.1748020

Removal of pancreatic stone
15.7048100

Biopsy of pancreas
12.2348120

Removal of pancreas lesion
15.8548140

Partial removal of pancreas
22.9448145

Partial removal of pancreas
24.0248146

Pancreatectomy
26.4048148

Removal of pancreatic duct
17.3448150

Partial removal of pancreas
48.0048150

Partial removal of pancreas
48.00( print page 31082)48152

Pancreatectomy
43.7548153

Pancreatectomy
47.8948154

Pancreatectomy
44.1048155

Removal of pancreas
24.6448180

Fuse pancreas and bowel
24.7248500

Surgery of pancreas cyst
15.2848510

Drain pancreatic pseudocyst
14.3148520

Fuse pancreas cyst and bowel
15.5948540

Fuse pancreas cyst and bowel
19.7248545

Pancreatorrhaphy
18.1848547

Duodenal exclusion
25.8349000

Exploration of abdomen
11.6849002

Reopening of abdomen
10.4949010

Exploration behind abdomen
12.2849020

Drain abdominal abscess
22.8449040

Drain, open, abdom abscess
13.5249060

Drain, open, retrop abscess
15.8649085

Remove abdomen foreign body
12.1449200

Removal of abdominal lesion
10.2549201

Removal of abdominal lesion
14.8449215

Excise sacral spine tumor
33.5049215

Excise sacral spine tumor
33.5049220

Multiple surgery, abdomen
14.8849255

Removal of omentum
11.1449320

Diag laparo separate proc
5.1049321

Laparoscopy; biopsy
5.4049322

Laparoscopy; aspiration
5.7049421

Insert abdominal drain
5.5449422

Remove perm cannula/catheter
6.2549425

Insert abdomen-venous drain
11.3749426

Revise abdomen-venous shunt
9.6349428

Ligation of shunt
6.0649429

Removal of shunt
7.4049495

Repair inguinal hernia, init
5.8949495

Repair inguinal hernia, init
5.8949496

Repair inguinal hernia, init
8.7949496

Repair inguinal hernia, init
8.7949500

Repair inguinal hernia
5.4849501

Repair inguinal hernia, init
8.8849505

Repair inguinal hernia
7.6049505

Repair inguinal hernia
7.6049507

Repair inguinal hernia
9.5749520

Rerepair inguinal hernia
9.6349521

Repair inguinal hernia, rec
11.9749525

Repair inguinal hernia
8.5749540

Repair lumbar hernia
10.3949550

Repair femoral hernia
8.6349553

Repair femoral hernia, init
9.4449555

Repair femoral hernia
9.0349557

Repair femoral hernia, recur
11.1549560

Repair abdominal hernia
11.5749561

Repair incisional hernia
14.2549565

Rerepair abdominal hernia
11.5749566

Repair incisional hernia
14.4049570

Repair epigastric hernia
5.6949572

Repair epigastric hernia
6.7349580

Repair umbilical hernia
4.1149582

Repair umbilical hernia
6.6549585

Repair umbilical hernia
6.2349587

Repair umbilical hernia
7.5649590

Repair abdominal hernia
8.5449605

Repair umbilical lesion
22.6649606

Repair umbilical lesion
18.6049650

Laparo hernia repair initial
6.2749651

Laparo hernia repair recur
8.2449900

Repair of abdominal wall
12.28( print page 31083)49905

Omental flap
6.5550200

Biopsy of kidney
2.6350230

Removal of kidney
22.0751595

Remove bladder/revise tract
37.1451596

Remove bladder/create pouch
39.5256515

Destruction, vulva lesion(s)
2.7656740

Remove vagina gland lesion
4.5757100

Biopsy of vagina
1.2057130

Remove vagina lesion
2.4357292

Construct vagina with graft
13.0957307

Fistula repair & colostomy
15.9357410

Pelvic examination
1.7557505

Endocervical curettage
1.1458150

Total hysterectomy
15.2458152

Total hysterectomy
20.6058260

Vaginal hysterectomy
12.9858262

Vaginal hysterectomy
14.7758263

Vaginal hysterectomy
16.0658267

Hysterectomy & vagina repair
17.0458270

Hysterectomy & vagina repair
14.2658275

Hysterectomy/revise vagina
15.7658280

Hysterectomy/revise vagina
17.0158285

Extensive hysterectomy
22.2658323

Sperm washing
0.2358400

Suspension of uterus
6.3658600

Division of fallopian tube
5.6058605

Division of fallopian tube
5.0058611

Ligate oviduct(s) add-on
1.4558700

Removal of fallopian tube
12.0558740

Revise fallopian tube(s)
14.0058805

Drainage of ovarian cyst(s)
5.8858820

Drain ovary abscess, open
4.2258825

Transposition, ovary(s)
10.9858920

Partial removal of ovary(s)
11.3658950

Resect ovarian malignancy
16.9358951

Resect ovarian malignancy
22.3859150

Treat ectopic pregnancy
11.6759151

Treat ectopic pregnancy
11.4959812

Treatment of miscarriage
4.0159870

Evacuate mole of uterus
6.0160100

Biopsy of thyroid
1.5660220

Partial removal of thyroid
11.9060220

Partial removal of thyroid
11.9060252

Removal of thyroid
20.5760254

Extensive thyroid surgery
26.9960260

Repeat thyroid surgery
17.4760270

Removal of thyroid
20.2760271

Removal of thyroid
16.8360540

Explore adrenal gland
17.0360545

Explore adrenal gland
19.8862263

Lysis epidural adhesions
6.1462310

Inject spine c/t
1.9162311

Inject spine l/s (cd)
1.5462318

Inject spine w/cath, c/t
2.0462319

Inject spine w/cath l/s (cd)
1.8765855

Laser surgery of eye
3.8566180

Implant eye shunt
14.5566986

Exchange lens prosthesis
12.2867028

Injection eye drug
2.5267218

Treatment of retinal lesion
18.5367904

Repair eyelid defect
6.2669990

Microsurgery add-on
3.4772275

Epidurography
0.7676005

Fluoroguide for spine inject
0.6076065

X-rays, bone evaluation
0.7076090

Mammogram, one breast
0.70( print page 31084)76091

Mammogram, both breasts
0.8776095

Stereotactic breast biopsy
1.5988170

Fine needle aspiration
1.2788171

Fine needle aspiration
1.2790901

Biofeedback train, any meth
0.4190911

Biofeedback peri/uro/rectal
0.8990935

Hemodialysis, one evaluation
1.2290937

Hemodialysis, repeated eval
2.1190945

Dialysis, one evaluation
1.2890947

Dialysis, repeated eval
2.1690989

Dialysis training, complete
0.0090993

Dialysis training, incompl
0.0090997

Hemoperfusion
1.8492018

New eye exam & treatment
2.5093350

Echo transthoracic
1.4894640

Airway inhalation treatment
0.0094664

Aerosol or vapor inhalations
0.0094665

Aerosol or vapor inhalations
0.0096100

Psychological testing
0.0096105

Assessment of aphasia
0.0096110

Developmental test, lim
0.0096115

Neurobehavior status exam
0.0096117

Neuropsych test battery
0.0097542

Wheelchair mngmnt training
0.4599233

Subsequent hospital care
1.5199273

Confirmatory consultation
1.1999274

Confirmatory consultation
1.7399291

Critical care, first hour
4.0099291

Critical care, first hour
4.0099291

Critical care, first hour
4.0099292

Critical care, addl 30 min
2.0099292

Critical care, addl 30 min
2.0099292

Critical care, addl 30 min
2.0099295

Neonatal critical care
16.0099296

Neonatal critical care
8.0099297

Neonatal critical care
4.0099298

Neonatal critical care
2.7599436

Attendance, birth
1.5099440

Newborn resuscitation
2.931
                            All CPT codes and descriptors copyright 2000 American Medical Association


[FR Doc. 01-14336 Filed 6-7-01; 8:45 am] BILLING CODE 4120-01-P