The history of coding and reimbursement for breast procedures demonstrates - for a single family of codes - many of the principles and, at times unexpected, outcomes of the CPT/RUC/CMS development and valuation process. This ranges from codes based until recently on the original Harvard surveys (19303), through updated surveys based on “rank order” anomaly (19301), to unexpectedly high RVU’s based on practice expense and site-of-service (19296). An understanding of how the formal CPT/RUC processes have impacted current breast codes provides insight into how the current code family functions, and may help predict how codes will be developed and valued in the future.
KeywordsSentinel Lymph Node Sentinel Lymph Node Biopsy Sentinel Lymph Node Mapping Total Mastectomy Partial Breast Irradiation
- 1.Clauser SB, Fanta CM, Finkel AJ, et al. Physicians’ current procedural terminology. 4th ed. Chicago: American Medical Association; 1985.Google Scholar
- 2.Hsiao WC, et al. A national study of resource-based relative value scales for physician services. Harvard University MFS refinement. Final report. 2nd vol. Appendices A through E.30 July1993. (Courtesy of Jan Nagle).Google Scholar
- 3.https://www.breastsurgeons.org/new_layout/programs/mastery/nsmr.php. Accessed 30 Aug 2015.
- 7.Federal Register/Vol. 71, No. 231/Friday, December 1, 2006/Rules and Regulations. p. 69624–65.Google Scholar
- 8.American Medical Association, RUC Database 2015, Version 2.0 (Copyright 2014 American Medical Association).Google Scholar