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CMS-1403-FC We agree with this recommendation and have made these changes in the PE database. CPT code 94770 was identified through the high IWPUT screen. In reviewing this diagnostic procedure, the AMA RUC and the specialty society agreed that this test is currently being used inappropriately in the nonfacility setting. The AMA RUC agreed with the specialty society that this procedure is medically appropriate only in the facility setting (provided at the patient’s bedside) and that it should not be valued in the nonfacility setting. Therefore, the AMA RUC recommended that all of the PE inputs be removed from the nonfacility setting. We have accepted the AMA’s RUC recommendation and we have changed the PE database to reflect these changes. Table 26 includes codes identified in the screens identified above, as well as other CMS requests. 886
CMS-1403-FC TABLE 26: AMA RUC Recommendations for Potentially Misvalued Codes AMA RUC Rec Site of Service Screen High IWPUT Screen Shift from PE to Work Other CMS Request CPT CMS 2009 New Code Descriptor Decision WRVU Tech 11043 Debride tissue/muscle CPT Agree 3.04 X 11044 Debride tissue/bone CPT Agree 4.11 X 14000 Skin tissue rearrangement 6.19 Agree 6.19 X 14001 Skin tissue rearrangement 8.58 Agree 8.58 X 14020 Skin tissue rearrangement 7.02 Agree 7.02 X 14021 Skin tissue rearrangement 9.52 Agree 9.52 X 14040 Skin tissue rearrangement 8.44 Agree 8.44 X 14041 Skin tissue rearrangement 10.63 Agree 10.63 X 14060 Skin tissue rearrangement 9.07 Agree 9.07 X 14061 Skin tissue rearrangement 11.25 Agree 11.25 X 14300 Skin tissue rearrangement CPT Agree 13.26 X X 15570 Form skin pedicle flap 10.00 Agree 10.00 X 15572 Form skin pedicle flap 9.94 Agree 9.94 X 15574 Form skin pedicle flap 10.52 Agree 10.52 X 15576 Form skin pedicle flap 9.24 Agree 9.24 X 15740 Island pedicle flap graft CPT Agree 11.57 X X 17106 Destruction of skin lesions 3.61 Agree 3.61 X 17107 Destruction of skin lesions 4.68 Agree 4.68 X 17108 Destruction of skin lesions 6.37 Agree 6.37 X 19357 Breast reconstruction CPT Agree 20.57 X 20005 Incision of deep abscess CPT Agree 3.55 X 20900 Removal of bone for graft 3.00 Agree 3.00 X 20902 Removal of bone for graft 4.58 Agree 4.58 X 21015 Resection of facial tumor CPT Agree 5.59 X 21025 Excision of bone, lower jaw 9.87 Agree 9.87 X 21557 Remove tumor neck/chest CPT Agree 8.91 X 21935 Remove tumor, back CPT Agree 18.38 X High Volume 887
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<strong>CMS</strong>-1403-FC<br />
We agree with this recommendation and have made these<br />
changes in the PE database.<br />
CPT code 94770 was identified through the high IWPUT<br />
screen. In reviewing this diagnostic procedure, the AMA<br />
RUC and the specialty society agreed that this test is<br />
currently being used inappropriately in the nonfacility<br />
setting. The AMA RUC agreed with the specialty society<br />
that this procedure is medically appropriate only in the<br />
facility setting (provided at the patient’s bedside) and<br />
that it should not be valued in the nonfacility setting.<br />
Therefore, the AMA RUC recommended that all of the PE inputs<br />
be removed from the nonfacility setting. We have accepted<br />
the AMA’s RUC recommendation and we have changed the PE<br />
database to reflect these changes.<br />
Table 26 includes codes identified in the screens<br />
identified above, as well as other <strong>CMS</strong> requests.<br />
886
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