This week’s update includes information on the May Current Procedural Terminology (CPT) Editorial Panel Meeting, as well as draft prior authorization legislation.
Current Procedural Terminology (CPT) Editorial Panel Meeting – May 2019
AUA CPT Advisor Dr. Ronald P. Kaufman, Jr., and Alternate Advisor and Coding & Reimbursement Committee Chair Dr. Jonathan Rubenstein represented the AUA at the American Medical Association CPT Editorial Panel meeting last week. Drs. Kaufman and Rubenstein specifically addressed issues submitted by industry that impact urology that industry submitted. The AMA CPT Public Agenda for this meeting included Category I Transrectal High Intensity Focused US Prostate Ablation (HIFU), Multianalyte Assays with Algorithmic Analyses (MAAA) Prostate Cancer Metastasis Risk Score, Category III Transurethral US-Guided Ablation of Prostate and Cat III Posterior Tibial Nerve Neurostimulation. If these codes are approved, they will be available in January 2021. Any Category I CPT code approved will be RUC surveyed for valuation. The MAAA laboratory test - if approved for coverage - will be paid under the Medicare Laboratory Fee Schedule and Category III codes will be priced by Medicare contractors.
The full CPT agenda is posted here.
Reducing Regulatory Burdens: Prior Authorization Update
On May 9, the AUA received an updated draft of the prior authorization bill sponsored by Reps. Mike Kelly (R-PA-16), Roger Marshall, MD (R-KS-1), Susan DelBene (D-WA-1) and Ami Bera, MD (D-CA-7). The AUA actively is engaged in quickly moving negotiations on the legislation with the Regulatory Relief Coalition, and this pending legislation was one of three congressional “asks” during the 2019 AUA Summit. The bill calls for automating prior authorization requests, increasing transparency in prior authorization processes, and prohibiting Medicare Advantage plans from imposing additional prior authorization requirements on surgeries and other invasive procedures. Its end goal is to reduce wait times for necessary operations and surgeries, and would be implemented by the Secretary of Health and Human Services, who will identify routine medical procedures to be included. The coalition is anticipating this measure to be formally introduced in the House within the next few weeks.
Congressional Outreach: AUA Continues to Meet with Freshman Offices
The AUA continued its outreach to an additional five freshman offices with the goal of introducing them to issues of concern in urology and how they affect patients. Between May 6 and May 9, the AUA met with staff in the offices of Reps. Jesus G. “Chuy” Garcia (D-IL-4), Chris Pappas (D-NH-1), Sean Casten (D-IL-6), Greg Gianforte (R-MT-1), and Kelly Armstrong (R-ND-At Large). Rep. Garcia’s office is open to supporting numerous of our legislative priorities, particularly because his wife suffers from multiple sclerosis and he understands the need for physicians and the importance of decreasing barriers to care. Reps. Gianforte and Armstrong’s offices were interested in the AUA’s work around reducing physician workforce shortages given the rural states they represent. Rep. Pappas’ office was one of numerous member offices that submitted the aforementioned appropriations request on the AUA’s behalf following their meetings with Summit delegates.
These were part of a series of meetings that the AUA is holding with freshman offices to educate them on the association and the key role urology plays in healthcare. We will keep you updated as more meetings are held.
On May 8, the AUA attended the National Institute of Diabetes and Digestive and Kidney Diseases’ (NIDDK) Subcouncil Meeting of the Division of Kidney, Urologic, and Hematologic Diseases. The meeting hosted stakeholders within the NIDDK community and featured subject matter presentations from disease-specific areas. Dr. Paul Lange represented the AUA and addressed specific needs in urologic research through a presentation that focused on the importance of surgeon-scientists and the benefits of surgeon-scientist collaboration with basic scientists. Dr. Lange encouraged additional collaboration with the AUA’s Office of Research team to help recruit and make successful MDs and PhDs in urologic research. The will continue communicating with NIDDK leadership to explore methods for attracting researchers interested in urology and creating sustainable funding opportunities.
On May 9, the AUA attended the Friends of National Institute of Child Health and Human Development’s (FoNICHD) stakeholder meeting where NICHD Director Dr. Diana Bianchi provided an overview of NICHD’s strategic planning update and key focus areas in 2020. Dr. Bianchi provided an overview of her testimony at the Fiscal Year (FY) 2020 House Appropriations hearing where she fielded questions about maternal health and pediatric research. Stakeholders are optimistic that there will be funding increases in FY20 for the National Institutes of Health (NIH) that include $1.580 billion for NICHD. Dr. Bianchi thanked stakeholders for providing feedback to NICHD’s strategic plan and stated that NICHD will release a final strategic plan in fall 2019. The AUA’s Research Advocacy Committee will continue to work proactively with NICHD and provide comments and recommendations as requested.
Partner Outreach to Elevate AUA Advocacy Efforts
The AUA continued individualized meetings with patient advocacy organizations to identify areas of alignment among advocacy and legislative priorities. The AUA conducted meetings with the Simon Foundation for Continence and the Underactive Bladder Foundation. The Simon Foundation for Continence’s legislative priorities focus on patient access to care, specifically issues with reimbursement management products like diapers, as many of these conditions are incurable and management tools for their conditions are necessary for quality of life. The Underactive Bladder Foundation is primarily active through their website and referring visitors to other organizations, including the UCF, for additional resources. Both organizations participate in the AUA’s Bladder Health Alliance, and topics for upcoming meetings were discussed. The AUA will continue to conduct meetings with patient advocacy organizations and will keep you apprised of ongoing outreach.
Practice Management: Register Today for the AUA’s Regional Coding Seminar!
The AUA is returning to The Westin Las Vegas for our annual Las Vegas Coding Seminar, to be held July 19-20. Registration for this event is officially open. The seminar will feature experts in the field of urology, who will provide updates on coding changes, discussions of common coding questions and payment denials gathered from the AUA Coding Hotline. Our event is widely-praised by its attendees, with one suggesting that they “highly-recommend that physicians, managers, coders & billers of any level should attend.” The seminar will offer practical exercises to hone the skills of anyone in the practice who is involved with CPT, HCPCS, or ICD coding. Our seminar also will feature coding workshops to educate attendees on coding basics and discuss surgical coding challenges, as well as our auditing workshop, which will show our attendees how to face the challenges of E&M documentation head on.
Visit our website to view the seminar schedule for each day and register for the AUA Coding Seminar.
Insurance Updates: Week of May 13, 2019
Each week, the AUA publishes weekly updates on the lasted insurance issues pertaining to urology. This week's update includes important information on BCBS Minnesota's criteria change for its prostatic urethral lift medical policy, United Healthcare's revised posterior tibial nerve stimulation policy and changes in drug status from Tufts Health Plan. Read more here.