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The ARS is pursuing a variety of endeavors in the areas of practice management, reimbursement strategies, etc. This area of the ARS website summaries these efforts.
Michael J. Sillers, MD has assumed the chairperson position for the ARS Patient Advocacy Committee. He has requested has requested that you direct any comments, suggestions, and/or questions to his attention:
Michael J. Sillers, MD
1501 5th Ave S
Birmingham, AL 35233-1614
205-934-9779 (voice)
205-934-3993 (fax)
michael.sillers@ccc.uab.edu
The page contains files in Acrobat format. You will need the Adobe Acrobat Reader to review these documents. To download the Acrobat Reader, click here.
April 2002 Update
Click here for the latest report from Dr. Joe Jacobs, Chair of the ARS Patient Advocacy Committee.
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Massachusetts BlueCross/Blue Shield has introduced a new S-Code. For more info, click here.
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The ARS has taken the lead role in the practice expense update process for the rhinologic CPT codes. For more info, click here.
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Dr. Brent Senior, editor of ARS Nose News, has performed an informat survey of members about their routine postop care practice patterns. For more info, click here. Dr. Rebecca Gaugan, AAO BOG Chair-Elect offers additional comments, and Dr. Richard W. Waguespack, AAO Chair of the Carrier Relations Committee is seeking additional input from practicing otolaryngologists. For more info, click here.
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Please click here for the latest update.
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The ARS Patient Advocacy Committee continues to actively deal with continuing denial of reimbursement for various FESS related codes. The focus of this effort involves codes related to turbinate and septal procedures, which are often denied when performed with FESS. In addition, the Committee continues to monitor the debridement code 31237. Most recently we are aggressively pursuing denial of reimbursement for 61795 despite having been approved for reimbursement by HCFA. However, many states have not yet adopted this policy through their local medical management committee.
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The ARS (through its representative, Hogan & Hartson, LLP) requested that the AMA provide additional clarification about CPT code 61795. The AMA response clearly states that CPT code 61795 includes a range of extracranial procedures, including sinus surgery.
For further information, download the AMA letter by click here.
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The 2001 Correct Coding Initiative permits payment for 61795 when performed simultaneously with endoscopic sinus surgery. HCFA adopted this on a national level; however, a number of states, each of which has an independent review process, have not followed these guidelines. An example is New York. However, after writing to the medical director of Blue Cross New York and providing documentation of the Correct Coding Initiative as well as the information contained in the 2001 CPT manual, the policy was reversed to permit reimbursement. (Blue Cross is the administrator of Medicare in New York State.)
The HCFA letter is included in our site and can be downloaded. However, many commercial/local/managed care carriers are not accepting the HCFA guidelines. For instance, Blue Cross is refusing to follow the HCFA guidelines. We continue to pursue these issues in order to obtain a broad-based policy consistent with the HCFA guidelines.
The ARS continues to work on this problem. We strongly suggest that ARS members inform the ARS Board and the ARS Patient Advocacy Committee of their successes and problems with CPT 61795.
If you choose to appeal inappropriate reimbursement decisions with local carriers and payers, please consider using these documents:
ARS letter to HCFA
HCFA response
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RVU values for CPT codes are determined by the AMA Relative Value Update Committee based upon survey data from practicing physicians. Currently, the ARS is recruiting a panel of rhinologists for the review of RVU values for rhinology CPT codes. Click here for more information.
To download the volunteer information form, click here.
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The ARS Patient Advocacy Committee has been investigating the problem of third party payer reimbursement for FESS and postoperative care. For a summary of the Committee's initial recommendations, click here.
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In response to the ARS appeal of the 61795 bundling edits, HCFA decided to delete these edits. For more info, please see the HCFA response.
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Although the 2000 revision for CPT code 67195 now includes "extracranial" applications of stereotactic computer assisted navigation, HCFA has bundled this code with the various codes for endoscopic sinus surgery. As a result, reimbursement for 61795 for sinus procedures is now routinely denied. The ARS is appealing this decision. For a copy of the ARS letter to HCFA, please click here.
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