ASRA Pain Medicine Update

Cite as: Emerick T. ASRA Pain Medicine’s growing role in the American Medical Association (AMA) and the RVS Update Committee (RUC). ASRA Pain Medicine News 2023;48. https://doi.org/10.52211/asra050123.003.

In June 2022, ASRA Pain Medicine was granted specialty society membership in the American Medical Association (AMA) House of Delegates (HOD).¹ The HOD comprises more than 170 specialty society members and 600 voting delegates that meet twice yearly to conduct business on several key areas, including health legislation, public health policy, medical education, scientific integrity, and ethics.² Also, as a seated specialty society in the AMA HOD, ASRA Pain Medicine has representation on the Current Procedural Terminology® (CPT) Editorial Panel and Resource-Based Relative Value Scale (RBRVS) Update Committee (RUC) Advisory Committees.³ Participation in these important committees gives ASRA Pain Medicine a voice in advocating on behalf of its membership for appropriate coding and payment for pain medicine services.

The CPT Editorial Panel is responsible for maintaining the CPT code set. The panel is authorized by the AMA Board of Trustees to revise, update, or modify CPT codes, descriptors, rules, and guidelines. The panel is composed of 21 members. Originally established in the 1960s, in 1996 the Health Insurance Portability and Accountability Act (HIPAA) mandated the use of the Healthcare Common Procedures Coding System (HCPS) and CPT codes for all healthcare transactions and insurance reimbursement claims.

As a result, CPT codes have become critical to ensuring that clinicians have means for reporting the ever-evolving range of services provided to patients. ASRA Pain Medicine participates in the CPT Advisory Committee. The CPT Advisory Committee reviews CPT applications and provides input on these applications and other activities (eg, coding education activities) of the CPT Editorial Panel. ASRA Pain Medicine representatives may also submit applications to the CPT Editorial Panel to develop new or revise existing codes to better reflect the current practice of pain medicine.

The RUC is a committee within the AMA that reviews and makes recommendations of relative values of work for various billing codes.⁴ The inclusion of ASRA Pain Medicine in the AMA HOD and the RUC has been the culmination of the efforts of many of our ASRA Pain Medicine members during the last 7 years. Our society’s representation on the RUC gives our members a voice in the inner workings of how work that physicians perform is valued. Guidelines and recommendations from the RUC are then provided to the Centers for Medicare and Medicaid Services (CMS) each year.⁴ ASRA Pain Medicine’s involvement with the AMA is not new; prior to being seated in the AMA House of Delegates, ASRA Pain Medicine had previously worked with AMA’s Specialty and Service Society as well as AMA’s Pain Caucus.⁵ I had the privilege of attending the RUC as ASRA Pain Medicine's advisor to the committee for meetings in September 2022 and January 2023 and have already been involved in a number of discussions on procedures and CPT codes that affect our specialty.

Since 1991, the RUC has provided recommendations on CPT code values to CMS.⁴ The RUC comprises 32 volunteer members (most members are physicians from a variety of designated specialties) and meets three times yearly to review and set relative values for physician work and direct practice expense inputs (eg, supplies, equipment, and clinical labor) for new/revised codes that have been recently reviewed at CPT. In certain circumstances, the RUC may review existing codes identified by CMS or the RUC itself where a re-review of the codes is necessary because the code has met one or more screening criteria (eg, increased utilization over multiple years).³

Our membership on the RUC allows us to provide input and feedback on all changes or updates to current and potential new CPT codes that may affect physicians in our specialty.

We serve alongside other anesthesia-related societies, such as the American Society of Anesthesiologists (ASA), to give specific input and expert opinions to the RUC when pain-related CPT codes and policies are up for discussion. This ability to advise the RUC is critical given that only a small handful of RUC members may serve in a pain-related field, and even fewer may have experience with the individual procedure or CPT code that is up for discussion. Our membership on the RUC allows us to provide input and feedback on all changes or updates to current and potential new CPT codes that may affect physicians in our specialty. While the original legislation that established the RBRVS process mandated review of relative values every 5 years, CMS now requests public comments on an annual basis.

It is important for all physicians to understand the basics of CPT codes and work values. The total relative value of an individual CPT code is actually comprised of three individual components – the physician work component, the practice expense component, and the professional liability component.⁴ This value is then multiplied by a conversion factor set by CMS and also by a geographic factor to determine overall payments.³ During the RUC meetings, individual codes are discussed, and the RUC focuses on establishing recommendations on physician work (based on surveys sent out to practicing physicians) and the direct inputs (eg, clinical labor, supplies, and equipment) that help establish practice expense relative value units. The physician work component factors in the time for the service, the mental effort and judgment, stress due to perceived risk, and technical skill/physical effort required.³ Through our society’s inclusion on the RUC, we can provide valuable feedback to the RUC members on the individual factors that make up each component of the total relative value of each designated procedural code, thereby ensuring our work as physicians is adequately valued. Typically, more than 70% of the recommendations that RUC forwards to CMS are ultimately accepted.³

Two key takeaways from my time serving as a representative for ASRA Pain Medicine during the RUC meetings were the importance of completing society surveys and maintaining individual memberships in the AMA. When our society is surveyed for a code that is being brought to the RUC, it is extremely critical for our members to participate. The RUC’s recommendations are heavily influenced by the results of these surveys, and unfortunately, sometimes only a few dozen or less respondents complete surveys that affect almost all of us as ASRA Pain Medicine. For us to maintain specialty society membership status in the AMA, it is important for society members to join or maintain their AMA membership so that ASRA Pain Medicine meets the AMA’s requirements.

In general, ASRA Pain Medicine's involvement with the AMA allows us to collectively advocate for our specialty alongside other specialties with like minded interests. Examples of recent advocacy by the AMA include advocating against payment cuts related to the budget neutrality requirements (any increase in payments from higher work relative value units will be offset by a lower conversion factor to maintain budget neutrality), implementing inflationary updates for physicians, expansion and maintenance of telehealth services, and advocacy surrounding split/shared visits.⁴ Going forward, our society is in a strong position through our AMA HOD membership and our involvement on the RUC to continue advocating on a national level for the importance of our specialty and the wide range of offerings our members provide.

Trent Emerick, MD, MBA, is an associate professor of anesthesiology and perioperative medicine and bioengineering, and chronic pain medicine fellowship director and associate chief in the department of Anesthesiology and Perioperative Medicine at the University of Pittsburgh Medical Center.

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References

1. Delegates & federation societies. American Medical Association. https://www.ama-assn.org/house-delegates/hod-organization/delegates-federation-societies. Published February 7, 2023. Accessed March 10, 2023.
2. About the House of Delegates. American Medical Association. https://www.ama-assn.org/house-delegates/hod-organization/about-house-delegates. Published Month Day, Year.
3. RVS update process. American Medical Association. https://www.ama-assn.org/system/files/ruc-update-booklet.pdf. Published March 23, 2023. Accessed Accessed March 26, 2023.
4. RBRVS overview. American Medical Association. https://www.ama-assn.org/about/rvs-update-committee-ruc/rbrvs-overview. Published February 10, 2023. Accessed Accessed February 20, 2023
5. Buvanendran A. President’s message: ASRA collaborations with other medical societies enhance member benefits and help our patients. ASRA Pain Medicine News 2018; Volume Number. https://www.asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2018/11/06/president's-message-asra-collaborations-with-other-medical-societies-enhance-member-benefits-and-help-our-patients