GI Societies Meet with CMS on Sedation

GI Societies Meet with CMS on Sedation

R. Bruce Cameron, MD, FACG

ACG Representative to the AMA’s RVS Update Committee (RUC)

I recently had the chance to participate in a meeting at CMS and wanted ACG members to know that the College, working with AGA and ASGE, issued a coordinated communication from all three groups outlining the in-depth analysis and advocacy surrounding two proposed rules relating to 2017 Medicare reimbursement.  Here’s the joint communication with links to key documents that went to members of all three GI societies today:

“On September 6, ACG, AGA, and ASGE responded to major provisions in the 2017 Medicare Physician Fee Schedule (MPFS) Proposed Rule Payment Policy, as well as major provisions in the CY 2017 Hospital Outpatient Prospective Payment System (HOPPS)/Ambulatory Surgery Center (ASC) Proposed Rule.

Our societies recently met with CMS officials to reinforce our recommendations on important payment issues impacting GI in the proposed rules. During our meeting, we urged CMS to:

• Finalize the proposed new Healthcare Common Procedure Coding System (HCPCS) G-code for moderate sedation provided by the endoscopist. As previously reported, CMS accepted survey data our members provided in proposing to remove the value of 0.10 physician work relative value units (wRVUs) for moderate sedation for the majority of endoscopic procedures. As proposed, endoscopists who provide their own moderate sedation will report the new HCPCS G-code, and will experience no impact on physician work. Those who use anesthesia professionals will see a reduction in physician work RVUs and office practice expense for the majority of GI endoscopy procedures.

• Report moderate sedation for ERCP and esophageal dilation with the new HCPCS G-code, valued at 0.10 wRVUs. Without supporting rationale, CMS is proposing that ERCP and esophageal dilation procedures must be reported with the CPT code for general moderate sedation with a proposed value of 0.25 wRVUs. Our societies disagreed given that these procedures were originally valued with the other GI code families where moderate sedation was inherent.

• Reconcile and improve proposed facility fees for certain GI services in the hospital outpatient department ambulatory payment classifications (APCs), as well as in the ambulatory surgical center (ASC). Our societies addressed  several inconsistencies in the proposed assignment of APCs within the GI endoscopy code families. We urged CMS not to expand GI-specific  comprehensive APCs (C-APCs) for CY 2017 and urged the agency to become more transparent in the  development process for C-APCs.

Jointly, our societies have developed detailed summaries on proposed provisions in the 2017 Medicare Physician Fee Schedule and OPPS/ASC proposed rules to help members prepare for these proposed changes in 2017.

The three GI societies jointly submitted comment letters to CMS: Tri-Society Comment Letter to CMS on 2017 MPFS Proposed Rule and Tri-Society Comment Letter to CMS on CY 2017 OPPS/ASC Payment Rule.”