The AAO-HNS Seeks Coding and Valuation Champions

A core function of our health policy advocacy at the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) is our involvement in the description and valuation of services performed by the specialty. Specifically, our diligent participation in the American Medical Association’s (AMA) Current Procedural Terminology (CPT) and Relative Value Unit Update Committee (RUC) allows us to influence, to the best of our ability, decisions made around coding and reimbursement for the services our members provide. Effective engagement requires expertise from volunteer Academy members who provide clinical insight and guidance for CPT code applications, valuation surveys, and coding inquiries we receive from the AMA and our members.

Why are these roles so essential? Simply put, coding and valuation touch each of our members. The CPT codes available for use by the medical community impact the ability to offer effective and high-quality patient care. Commercial payers often follow Medicare when establishing their own reimbursement policies. Therefore, our CPT/RUC work at the AMA has a direct impact on private payer reimbursement as well. The Academy’s CPT/RUC team routinely engages with other physician societies on coding for procedures that have multispecialty usage. Many new code applications or surveys are a collaborative effort. Finally, the CPT/RUC team fields industry requests related to new technology and innovation in the practice of otolaryngology-head and neck surgery.

The CPT/RUC team works with the Health Policy Advocacy staff at the AAO-HNS and engages with the Physician Payment Policy working group (3P). Following are the roles, responsibilities, and expectations for these physician volunteers.

General expectations of CPT/RUC team volunteers:

• Participate in monthly 3P meetings (typically evening calls)
• Participate in monthly CPT/RUC team meetings (typically evening calls)
• Learn the process of CPT code development and subsequent valuation of codes

Key traits for success:

• Comfortable with adherence to deadlines
• Responsive to emails in a timely fashion
• Able to work collaboratively within the CPT/RUC team and with other specialties
• Comfortable with public speaking (e.g., presenting survey data and application information to the CPT and RUC panels)
• Able to maintain a calm demeanor in the face of harsh questioning and contentious conversations

CPT team expectations:

• Represent the AAO-HNS at the AMA CPT panel for up to three meetings per year (locations vary, and travel is often required)
• Participate in any ad-hoc CPT team meetings as needed based on the current workload
• Participate in meetings with industry partners to discuss coding initiatives and requests
• Learn the procedures for coding applications as well as the requirements and differences between category I and category III codes
• Answer CPT queries from the AMA regarding correct coding for procedures AAO-HNS members may perform
• Work with AAO-HNS staff to update coding resources regularly (All advice is “unofficial,” as AAO-HNS staff are not certified coders.)

RUC team expectations:

• Attend the standard three RUC meetings per year (locations vary, and travel is required)
• Attend any ad-hoc RUC team meetings as needed based on the current coding and survey initiatives
• Participate in all facets of the RUC survey and recommendation process, including reviewing survey data, written descriptions of procedure work, and written justifications for code times and values
• Participate in the CPT code creation process as it relates to the future RUC process, including code structure, wording, and vignettes

If you or your colleagues are interested in this type of work and feel that you or they would be a good candidate for consideration, please email a CV or any questions to healthpolicy@entnet.org.

We look forward to hearing from you and continuing the great work of the Academy and the CPT/RUC team to ensure appropriate reimbursement and coding for our members and the patients they serve.