PEDIATRICS Vol. 104 No. 3
September 1999,
pp. 577
Read This
It's Important
To the Editor.
The Current Procedural Terminology (CPT) Editorial Panel of the
American Medical Association recently issued its 1999 revisions. This
revised edition included the input of numerous medical specialties. The
American Academy of Pediatrics (AAP) agreed previously with the use of
the CPT codes and the Resource-Based Relative Value Scale (RBRVS)
physician fee schedule, but emphasized a need to rectify the inequities
of the CPT and RBRVS system.1 The AAP also filed recently
an amicus curiae brief with the US District Court for the
northern district of Illinois against a suit to decrease reimbursements
for pediatricians based on the RBRVS system.2 The RBRVS
physician fee schedule was established to recognize objective measures
of physician work, while creating equity in reimbursement for all
physician services across specialties. The RBRVS system is based on
uniform definitions of physician work defined as relative value units
(RVUs). An informal survey of pediatricians in our hospital revealed
none with knowledge about specific inequities of RVUs, although most
knew about the inequities of reimbursements. All were aware that RVUs
are used to assess physician performance and productivity at Baylor
College of Medicine and other institutions. A new billing software
program, e.bill, developed by the authors allows comparisons of
expected reimbursements and RVUs for all specialists. A demonstration
of the RVUs for procedure and nonprocedure specialties usually elicited shocking disbelief from the same pediatricians. For pediatricians without the time or means to pursue these inequities, we present several examples below:
|
|
|
| CPT
Code |
Medicare
Reimbursement |
RVU |
|
99213 Outpatient visit,
low, moderate severity, 15 minutes |
$40.45 |
1.13
|
| 11301Shaving, trunk, arms, legs, .6 to 1.0 cm |
$57.06 |
1.58 |
| 11313Shaving, face, ears, nose, over 2.0 cm |
$118.47 |
3.26 |
| 71020Radiographic examination, chest, two
views |
$35.63 |
.96 |
| 76020Bone age |
$30.39 |
.82
|
| 44955Appendectomy |
$532.04 |
14.6 |
| 99372Telephone call,
intermediate |
$0.00 |
.77 |
|
A surgeon shaving a 2.0 cm area of a patient's facial
hair in <1 minute (11313) earns almost three times the RVUs compared with a pediatrician evaluating a complex problem in 15 minutes (99213).
A radiologist reading a child's chest film in <2 minutes (71020)
earns almost the same RVUs compared with a pediatrician compiling 12 glucose levels from 3 days and adjusting NPH and regular insulin
administration in a diabetic child in a 15-minute telephone call. A
surgeon shaving only a 1.0 cm area of a child's leg in <1 minute
(11301) earns almost twice the number of RVUs compared with the above
pediatrician's telephone call. Furthermore, the radiologist and
surgeon receive Medicare reimbursements while the pediatrician does not
receive Medicaid reimbursements.
These examples demonstrate the need for pediatricians to become
involved and knowledgeable about the efforts to change the current
standards and to support the AAP in its efforts to promote equity with
procedure-oriented physicians. Pediatricians should refuse to accept
passively the latest RVUs associated with the CPT codes. Telephone
call, letters, e-mail, and political pressure should flood the offices
of those promulgating this inequitable system.
Philip R. Beckett, PhD and
John L. Kirkland, MD
Endocrine and Metabolism Section
Department of Pediatrics
Baylor College of Medicine
Houston, TX 77030
REFERENCES
-
Resource-Based Relative Value Scale Project Advisory Committee
Issues in the application of the resource-based relative value scale system to pediatrics: a subject review. American Academy of Pediatrics.
Pediatrics.
1998;
102:996-998 [Abstract/Free Full Text]
-
Szabo J
Washington Watch: P-C doctors back HCFA in suit over practice expenses.
Physicians Financial News.
1999;
17:17
Pediatrics (ISSN 0031 4005). Copyright ©1999 by the American Academy of Pediatrics
