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CMS-1403-FC
clinical rationale for increased utilization, and we will
continue to take this into consideration in future reviews.
C. AMA RUC Review of Potentially Misvalued Codes
The AMA RUC started to review potentially misvalued
codes using various screens, including codes with site of
service and high IWPUT anomalies and high volume and a new
technology designation, at the 2008 AMA RUC meetings.
Review of the identified clinical services revealed
204 codes. Of those codes, 48 were recommended for a
reduction in valuation; 38 were recommended to maintain the
same valuation; 105 were referred to CPT for further code
clarification; and 13 were recommended for an increase in
valuation.
All of these codes were reviewed and revalued by the
AMA RUC; other than the codes referred to CPT, we have
agreed to accept the valuation for these codes for CY 2009,
including the conforming changes to the PE inputs for these
codes, as applicable. We recognize that many of the site
of service anomaly code changes included deletion or
modification of hospital days, office visits, intraservice
time, and discharge day management services. We have
concerns that the methodology used by the AMA RUC to review
the services may have resulted in removal of hospital days
and deletion or reallocation of office visits without
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