Is Physician Work in Procedure and Test Codes More Highly Valued Than That in Evaluation and Management Codes?
Kerber KA, Raphaelson M, Barkley GL, and Burke JF. Is physician work in procedure and test codes more highly valued than that in evaluation and management codes? Ann Surg 2015; 262(2):267-272.
Annals of surgery
OBJECTIVES: To determine whether the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule confers higher value for physician work in procedure and test codes than in Evaluation and Management (E/M) codes.
BACKGROUND: Medicare Payment Advisory Commission previously demonstrated that time for medical services is the dominant element in valuing physician work in the CMS Physician Fee Schedule. In contrast, a more recent analysis suggests that more relative value units (RVUs) per unit time are issued for work in procedure codes than in E/M codes. Both prior analyses had important limitations for evaluating a possible systematic differential valuation of medical services.
METHODS: Data regarding RVUs, physician work times (minutes), and claims were obtained for all active level I Current Procedural Terminology (CPT) codes from 2011 CMS files. Linear regression was used to assess the associations of work time components and CPT category with work RVUs, including a model that weighted codes by the number of claims.
RESULTS: Included in the analysis were 6522 CPT codes (87 E/M codes, 6435 procedure/test codes). Compared with E/M codes, procedure/test codes did not have a significant difference in work RVUs adjusting for time (-0.631; 95% confidence interval, -1.427 to 0.166). The analysis also did not indicate a work RVU advantage specifically for Surgical CPT codes compared with E/M adjusting for time (-0.760; 95% confidence interval, -1.560 to 0.040). This pattern was not altered after weighting codes by the number of claims, indicating that an increase in RVUs per minute was not concentrated in a small number of highly utilized procedure codes.
CONCLUSIONS: We did not find evidence of a systematic higher valuation of physician work in procedure/test codes than in E/M codes in the CMS RVU system.
Medical Subject Headings
Current Procedural Terminology; Diagnostic Services; Fee Schedules; Humans; Medicaid; Medicare; Operative Time; Reimbursement Mechanisms; Surgical Procedures, Operative; United States