American Society of Plastic Surgeons
For Consumers

Coding Workshop Breaks Records Amid Major Changes

Ongoing COVID-19 travel restrictions forced the 2020 ASPS Coding Workshop to be canceled and resulted in the program becoming an online event in 2021. While a new format for this event, the virtual workshop was well-received by participants.

In addition to the accessibility of the virtual workshop, major changes made to the Current Procedural Terminology (CPT) codes helped spur attendance. Changes were made in two areas that are particularly impactful: Evaluation and Management (E&M) codes, and most notably, breast reconstruction codes.

The Workshop

The ASPS Plastic Surgery Coding Workshop is a peer-reviewed, comprehensive course focused on the broad issues of practice management and reimbursement. Another major component of the Workshop is case-based instruction on new coding standards. The event is designed to help surgeons, practice administrators, CFOs and plastic surgery billers/coders keep pace with changes to CPT coding specifically, and to understand better the proper coding for plastic surgery clinical scenarios.

The February 27 Workshop received record attendance, with more than 280 participants. The event also saw active engagement from attendees, as 526 questions were answered.

Breast code changes

Breast reconstruction codes were targeted as part of the American Medical Association's (AMA) long-term goal of removing ambiguous codes/confusing language from the CPT book. These codes were identified specifically due to a long-standing confusion outside plastic surgery related to breast reconstruction coding and ongoing concerns from AMA related to how multiple codes could all start with, "breast reconstruction." AMA also felt that the codes were poorly defined.

An additional factor in the focus on breast reconstruction codes was increasing pressure from insurers due to what they perceived as "unbundling" of like services, and the many changes in breast reconstruction techniques and practices over the last 20+ years. As a result, ASPS crafted 14 paragraphs of introductory language to the CPT book to better explain breast coding.

The CPT's origins and update process

Developed by the AMA in 1966, the CPT is a standard language that is used to describe medical, surgical, and diagnostic services. It was created with the aim of improving and streamlining communication between health care providers, patients, and third parties. It was later adopted as part of the Healthcare Common Procedure Coding System of what is now the Centers for Medicare & Medicaid Services (CMS) for the purpose of reporting and seeking reimbursement for services provided to Medicare beneficiaries.

CPT is the standard procedural coding set for physician services, as specified by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The process for updating the CPT is overseen by the AMA CPT Editorial Panel and supported by the CPT Advisory Committee, which includes representatives from 90 medical specialty societies and health care professional organizations. The CPT Editorial Panel ultimately determines what CPT codes should be added, modified, or deleted in the annual CPT manual.

The AMA publishes an annual CPT manual, which is organized by specialty and supported by clinical examples and scenarios to assist in coding.

Input from individual ASPS members is critical in determining the value of physician services. To ensure the valuation of CPT codes remains relevant and compliant with federal law, CPT codes' Relative Value Units (RVUs) are regularly updated through the AMA's Relative Value Scale Update Committee (RUC).

The process for determining the relative value of physician services relies on survey data from specialty society members. When revisions to a CPT code are being contemplated, organizations representing specialties impacted by the code – like ASPS with breast reconstruction codes, for example – are charged with surveying their physician members to determine the time, intensity, and complexity of a procedure. Those factors are then used to value a procedure relative to the entire fee schedule through the assignment of an RVU.

The RUC heavily weighs specialty input when making decisions about RVU weighting. They have to appropriately distribute a statutorily limited pool of money, so the feedback from physician specialists on what they see as the value of their specific procedures is critical. When the data supporting a specialty's claim is insufficient, though, any arguments that a valuation is inappropriately low are seen as unsubstantiated. Only good data makes for good arguments with the RUC.

In spite of this, response rates by ASPS members to these surveys has historically been disappointing. The last CPT survey drew a sub-five percent response rate, for example. Virtually every ASPS member who has indicated that breast reconstruction is a part of their practice profile received the survey. But – based on the plastic surgery community's reaction to the revaluation of breast reconstruction codes – not enough of those surgeons shared their expertise and input of what accurately reflects value of these services.

ASPS urges members to respond to future requests for feedback on the value of CPT codes so the specialty is better positioned to argue that future proposed CPT values are inappropriately low.