CMS' 2019 physician fee schedule includes potentially misvalued codes for total hip and knee arthroplasty, according to the American Association of Hip and Knee Surgeons.
Here are the key details to know:
1. CMS identified seven high volume current procedural terminology codes as potentially misvalued, including those for total hip and knee arthroplasty. CMS requested the Relative Value Update Committee of the American Medical Association re-evaluate the work for these procedures.
2. A subcommittee of the RUC found there wasn't a reason to re-evaluate the total hip and knee codes in October 2018. AAHKS said physician-led initiatives have created significant quality improvements in total hip and knee procedures, leading to increased value.
3. Specifically, the AAHKS said the cost of a 90-day episode of care has been reduced by 50 percent without affecting quality, and the organization does not believe the codes should be reviewed by RUC.
4. Lowering the value of the codes would add to the supply-side crisis and threaten access for patients, the AAHKS said.
"Our members have worked very hard over the past decade to improve the quality of care they provide for patients undergoing hip and knee arthroplasty while simultaneously partnering with payers including the federal government to lower costs. Given the high societal value that these procedures provide, penalizing the surgeon for improvements in care seems unfair, misguided and may threaten access to care," said AAHKS President Craig J. Della Valle, MD, in a release.