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PRACTICE MANAGEMENT

Coding and Reimbursement Center - The RUC Process

This resource has been developed by the Practice Management Committee to assist ASGE members in properly coding gastrointestinal endoscopy services. Here, you will find coding-related ASGE articles and links to other important information to help you better understand coding.

Costs and Colonoscopy: Q & A Guide for Talking to Patients

ASGE, ACG and AGA have prepared a Q & A guide to help members talk to patients who ask about costs and colonoscopy. Download the Q & A 

Industry CPT Coding Assistance

The American Gastroenterological Association (AGA), the American College of Gastroenterology (ACG) and the American Society for Gastrointestinal Endoscopy (ASGE) have an active role in establishing and/or revising CPT® codes for new/existing procedures relevant to the practice of gastroenterology.

ASGE Reimbursement Activities

The AMA/Specialty Society Relative Value Update Committee (RUC) is a unique multi-specialty committee tasked with making relative value recommendations to CMS for new and revised codes, as well as annually updating relative value units (RVUs) to reflect changes in medical practice.

The purpose of the RUC process is to provide recommendations to CMS for use in annual updates to the new Medicare relative value scale. These recommendations are based on data collected from surveys of practicing physicians regarding the time, intensity and complexity of new and revised CPT codes.

The RUC process cannot work without you.

The RUC makes recommendations based on your direct input through physician surveys. Do not forfeit this important opportunity to provide direct input into the valuation of GI services.
To volunteer to participate in the survey process, email surveys@asge.org with your name and contact information. Based on the list of surveys below, please specify which procedure surveys apply to you. Additional information will be provided prior to the start of each survey.

The Survey Process Requires Physician Input

For the RUC survey process to succeed, the cooperation and participation of practicing physicians is essential. It is only with your input that we can provide the RUC and CMS with accurate data so gastroenterology services can be fairly valued by Medicare. Many private insurers also base their rates on a percentage of Medicare, resulting in a wide and significant impact of this process.

Our societies need to expand our database of practitioners who are able to complete the work surveys we use to recommend RVUs for procedures, including both existing codes under review and new codes that may come up in the future. Gastroenterologists who perform routine exams, such as colonoscopy and esophagogastroduodenoscopy (EGD), and more complex exams, such as endoscopic retrograde cholangiopancreatography (ERCP), are needed.

We realize practicing physicians are faced with increasing demands on their time, but we believe this is an important, valuable and unique opportunity for any practicing gastroenterologist. By participating in a RUC survey, you will be able to have direct input on the valuation of the services you provide. 

If you are contacted via e-mail to participate in RUC surveys, we urge you to complete them. If you are able to assist, please RSVP to surveys@asge.org as soon as possible and include your name, email address and practice location.

The Endoscopy Survey Timeline

 

 

Procedure Family

Code Range

Survey Date

Esophagoscopy

43200–43234

Complete

Dilation

43450–43458

Complete

EGD

43235–43259

Fall 2012

ERCP

43260–43273

Winter 2013

Enteroscopy

44360–44373

Winter 2013

Enteroscopy to ileum

44376–44382

Winter 2013

Ileoscopy

44380–44386

Summer 2013

Flexible sigmoidscopy

45330–45345

Summer 2013

Colonoscopy through stoma

44387–44397

Fall 2013

Colonoscopy

45378–45392

Fall 2013

The Basics of the RUC Survey Process

When new codes are established or existing codes are revised, a survey of physicians providing that service is conducted by the relevant medical specialty society. The purpose of the survey is to measure physician work involved in performing the procedure to determine an accurate relative value recommendation for the service. ASGE and AGA conduct surveys for gastroenterology services, analyze the results and present recommendations to the RUC. 

The AMA defines physician work as:

  • Physician time it takes to perform a service.
  • Physician mental effort and judgment.
  • Physician technical skill and physical effort.
  • Physician psychological stress that occurs when an adverse outcome has serious consequences.

In May of every year, the RUC submits its recommendations to CMS. In the summer, through the federal regulations process, CMS publishes proposed work values. After the public comment process, the new values are finalized and implemented on Jan. 1 of the following year. Historically, CMS has accepted almost 90 percent of the RUC’s recommendations.

Read more about the RUC.

Download a PDF presentation on understanding the survey instrument.

Read the RUC Survey Instrument FAQs

 

How Medicare Sets Physician Payment Rates

In 1992, Medicare implemented a cost-based physician fee schedule. For each of the greater than 7,000 services on the fee schedule, an RVU is assigned based on the time and intensity of physician work, practice expense and cost of professional liability insurance necessary to provide the service. To determine the Medicare fee, a service's RVUs are multiplied by a dollar conversion factor that is updated annually. A geographic adjustment is also made.

When Medicare transitioned to a physician payment system based on the Resource-Based Relative Value Scale (RBRVS), the AMA anticipated the effects of this change and formulated a multi-specialty committee. This committee, known as the AMA RVS Update Committee (RUC), has made numerous recommendations to CMS that have significantly affected the Medicare physician payment schedule by giving physicians a voice in shaping Medicare relative values. The RUC, in conjunction with the Current Procedural Terminology Editorial Panel, has created a process through which specialty societies can develop relative value recommendations for new and revised codes. The RUC carefully reviews survey data presented by specialty societies and develops recommendations for consideration by CMS. ASGE and AGA are active participants in the RUC.

The ASGE needs your help! 

For the RUC survey process to succeed, the cooperation and participation of practicing physicians is critical. It is only with your input that we can provide the RUC and CMS with accurate data so gastroenterology services can be fairly valued by Medicare. It is important to note that the impact of this process is not isolated to Medicare. Many private insurers base their rates on a percentage of Medicare resulting in a wide and significant impact for this process that can potentially influence many payers beyond Medicare.

If you would like to be added to the roster please send your contact information to: surveys@asge.org 

More information about the RUC is available on-line at: www.ama-assn.org/go/rbrvs 

Coding Resources: ASGE’s Coding Questions Center

 

ASGE Coding Resources

ASGE Online Coding Primer
A "how-to" guide to proper code assignment. Refining your coding knowledge. (a more complete version of this online resource is available in the 2009 Coding Primer: a Guide for Gastroenterologists)

What’s New in Coding: