Legacy of Excellence Digital Flipbook

LEGACY OF EXCELLENCE

the specialty was faced with multiplying detrimental national policies and local payer denials and gaps in coverage. One of the most frustrating results of these variable policies stemmed from the lack of consistency among private payer health plans and further differences in government programs. The following are some of the coverage topics the Academy tackled during this timeframe: • Balloon Sinus Ostial Dilation • Modifier 62 (in conjunction with CPT code 62165) • Post-Op Sinus Endoscopy and/or Debridement Procedures • Post-Op Nasal Debridement After Endoscopic Sinus Surgery • Sinus Implantable Devices • Modifier 25 (with E/M services) • Eustachian Tube Balloon Dilation • Telehealth Flexibility • Hypoglossal Nerve Stimulation Coverage for Treatment of Obstructive Sleep Apnea • Hybrid Cochlear Implants • New Diagnostic Fiberoptic Flexible Laryngoscopy • Injectable Bulking Agents for Vocal Cord Insufficiency In addressing these and other policies, the Academy relied on multiple avenues to identify coverage topics for prioritization, including member notifications and the payers’ monthly newsletters. Once a medical policy was flagged, it underwent a thorough review by members of the Advocacy team, Dr. Denneny, and Dr. Manes. Advocating for the specialty and submitting communications to payers was an ongoing and collaborative effort as these efforts often required the engagement of physician member experts or the AAO HNS/F committees for additional clinical input and evidence to contest payers’ policies. CPT Codes AAO-HNS members were represented at the American Medical Association (AMA)/Specialty Society RUC and AMA CPT Editorial Panel meetings by the AAO HNS Physician Payment Policy (3P) Workgroup’s RUC and CPT team members. The RUC and CPT teams work with AAO-HNS committees, specialty societies, other medical specialties and stakeholders, to represent members’ best interests by advocating for pertinent • Indications for Surgery • Pre-authorization Polices

new codes; skillfully navigating each meeting to ensure proper valuation of new and established codes; and assisting with the review of existing codes. It was important that the Academy worked with industry to ensure that valuable new treatments and devices were available for members and their patients. As in years past, the Academy was an active participant in both the AMA RUC valuation of otolaryngology-head and neck services and the CMS annual rulemaking processes. As part of those efforts to maintain value in procedures that had been dwindling for 10+ years, the Academy advocated to ensure members were informed and prepared for key changes to CPT codes and valuations related to otolaryngology head and neck surgery service. A joint effort of the AMA and medical specialty societies, the RUC made recommendations on revising and updating the resource-based relative value scale (RBRVS), which was utilized by Medicare and many private payers to determine reimbursement for medical services. Information, such as the time and intensity it takes to perform certain services for patients, was derived by surveying physicians and was essential when valuing physician services provided to Medicare beneficiaries. The Academy provided several comprehensive resources to aid AAO-HNS members in their practice decision on all coding matters. Some highlights from 2017-2021 include the creation of new CPT codes, effective in January 2021, for Absorbable Nasal Implant Repair and Dilation of Eustachian Tube, and at the October 2020 AMA CPT Editorial Panel meeting, the AMA accepted new Category I CPT codes for both hypoglossal nerve stimulation and drug-induced sleep endoscopy, effective in 2022. State Level Advocacy State Trackers Network was active and thriving from 2017-2020 with more than 170 physician volunteers AA -HNS STATE TRACKERS

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