Advocacy


Fighting for value The evolution of SIR coding advocacy


CPT terms to know


CPT® codes: Current Procedural Terminology, or CPT® codes, are numbers used to identify medical services and procedures. Healthcare providers use CPT® codes for billing, reporting and administration and are developed, maintained and copyrighted by the American Medical Association in conjunction with qualified healthcare professionals or associations.


SIR’s Economics Committee: SIR’s volunteer committee, which is comprised of four work groups: the SIR CPT® Editorial Panel and RUC work group, the Coding Application and Guidance work group, the Carrier Advocacy work group, and the soon-to-come Alternative Payment Model work group.


The AMA CPT® Editorial Panel: A panel of experts, supported by CPT® Advisor physicians nominated by the medical specialty societies to revise, update or delete CPT® codes and descriptors. Category I codes approved by the CPT® Editorial Panel are then sent to the Relative Value Update Committee (RUC) for valuation.


The RVS Update Committee: The Relative Value Update Committee (RUC) is an expert panel of volunteer physicians who advise the Centers for Medicare & Medicaid Services on how to value physicians’ work.


Want to know how a code gets approved? Check out Coding the future on irq.sirweb.org.


2005 F


or over 4 decades, interventional radiologists, in conjunction with the Society of Interventional Radiology, have been creating, editing, campaigning and supporting new and evolving billing codes that reflect the full gamut of IR therapies. Today, CPT® codes describe healthcare services and procedures and are used by Medicare, Medicaid and private insurers to determine reimbursement rates.


“Interventional radiology early on was this innovative, almost niche, specialty—but from a policy perspective, we had to establish our identity,” said Ezequiel Silva III, MD, FSIR, who serves as the chair of the American Medical Association RVS Update Committee (RUC). “There were very practical considerations; for example, we needed to be separately identified by policymakers as interventional radiologists. We wanted to be able to bill for our services and have procedural codes that not only described what we did but also reimbursed fairly for what we did. We wanted to have consistent procedural codes for health-policy research.”


When billing for services, Dr. Silva said, IRs wanted a clear specialty identifier.


“It was a very important step for our specialty,” he said. “It took a lot of involvement and engagement—both at a specialty—society level and also getting out there in the trenches and working with regulators such as Medicare, as well as lawmakers, to have ourselves identified within statute and law. It took a sort of public relations campaign to get our name and recognition out there.”


2006 Certificate Committee; APDIR established


The Primary Certificate Task Force was established within SIR to pursue a primary certificate in IR, and years of intensive work ensue. Meanwhile, SIR creates its first member section, the Association of Program Directors in IR (APDIR). This section provides a forum for discussing the challenges facing IR and supplies teaching guidelines.


26 IRQ | WINTER 2025 2007


Learn more about IR coding history in Dr. Silva’s 2024 Dotter Lecture preview. irq.sirweb.org/ sirtoday/dotter-zeke-silva


Dr. Silva presented the 2024 Charles T. Dotter Lecture, which focused on the importance of IR coding advocacy and reflected on how crucial these early coding achievements were for IR evolution.


“In 1990, William Hsiao was creating a new Medicare system that revamped how physicians were reimbursed,” Dr. Silva said. “IR made a play for the inclusion of component billing, rather than complete coding.” Essentially, this would allow for the creation of CPT® codes that better reflected the reality of IR procedures and described them alongside other procedural specialties, thus enabling more reliable reimbursement and better data for health-policy research.


“By the time 1992 rolled around, IR had achieved wins with component coding, surgical and radiology coding, meaningful valuation, and recognition as a specialty,” Dr. Silva said. “It was nothing short of remarkable.”


Dr. Silva’s full Dotter Lecture is available online at jvir.org.


Silva, E. 2024 Dotter Lecture: Innovation in IR Public Policy: Then and Now. JVIR. 2024;35(11):1583-1590.


2008


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40