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	April 2004 Meeting
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Reimbursement Committee Meeting

APRIL 30, 2004
ORLANDO, FLORIDA

The Reimbursement Committee met at 12 noon, Friday, April 30 in the Challenger Room at the Peabody Hotel. Committee members present included Drs. Aaron Cohen-Gadol, Holly Gilmer-Hill, A.B. Kliefoth, John Krettek, Lyal Leibrock, Steve Ryu, Bob Schwetschenau, John Wilson(Vice-Chairperson), and Gregory Przybylski (Chairperson).

The meeting began with an introduction of the AANS and CNS advisors to the CPT Editorial Panel and the Relative Value Update Committee. A brief review of the CPT and RUC process was given.

We discussed assigned Resolution VI regarding a CSNS statement that it is “ethical for individual neurosurgeons to refuse participation in Medicare”. Although Committee members agreed with the spirit of the resolution, all shared concerns about the way the resolution was written, as well as its focus on Medicare only. The resolution itself was also felt to be unclear as to whether it meant no longer seeing Medicare patients or simply becoming a non-participating physician with Medicare. It was felt that the same issue applied to non-government third party insurers as well. It was suggested that support for the sentiment of the resolution, but a request for a revision in the language be presented to the CSNS during resolution testimony. Alternative language suggested that a positive statement that supports an individual neurosurgeon’s freedom to choose not to participate in third party insurance programs be given.

We discussed Resolution I regarding a change in the Rules and Regulations to allow CNS and AANS appointees to be elected officers with the CSNS and the second resolve that these appointees, once elected, would forfeit their appointee status until their term of office had ended. The Committee was in support of this resolution. We looked back at the Rules and Regulations which demonstrated that a CSNS delegate that was elected as an officer may or may not retain their delegate status depending on the wishes of the state from which they were elected. We felt that appointees should likewise not be forced for forfeit their appointee status unless the AANS or CNS asked them to do so. We will also speak to that resolution during the resolution testimony.

We reviewed the CPT and RUC actions since the last meeting in October. New codes for lamioplasty have been developed and valued. Codes for deep brain stimulation re-programming were also developed and separated from the prior codes that were used for spinal cord stimulation. These were likewise valued at the April RUC meeting. Finally, carotid stenting has been changed from a Category III code to a Category I code and was also valued at the April meeting. We discussed an issue that will be brought before the Coding and Reimbursement Committee regarding the use of threaded bone dows as a prosthetic device under CPT code 22851. The Committee did not voice opposition to removing the threaded bone dow from the parenthetical statement in the CPT language for this code. We briefly discussed the upcoming 5 year review. A question regarding the status of peripheral nerve surgery codes was given. We discussed the process of requesting either CPT language changes or value changes in the 5 year review process. Finally, we discussed the professional liability component of the Medicare RVU and the reason why the values changed very little in this year.

The Committee adjourned at l:40pm.

Respectfully submitted:

Gregory Przybylski, M.D.
Chairperson