Kathy Krol, MD, FSIR, an ex officio member of SIR’s Economics Committee, began her journey through coding advocacy when she was a new volunteer with SIR—then the Society of Cardiovascular and Interventional Radiology—and had a front seat to the IR coding evolution.
“It became an area of interest for me. We could advocate for patients, but also for physicians, by aiming to get payments set at a point that services are available to patients,” Dr. Krol said. “If the payment is set too high, payors will not cover the service, and it won’t be available to patients. If the payment is set too low, providers will not perform the service, and it won’t be available to patients.”
Dr. Krol’s first coding experience was on a nephrostomy code; she was asked to partake in a survey by the RUC Panel, which was attempting to value all the existing codes when the RBRVS system was instituted. She then went on to write and present at a CPT® Editorial Panel meeting regarding dialysis access intervention codes.
Since then, Dr. Krol has served as the SIR CPT® advisor, as well as a member of the AMA CPT® Editorial Panel. She’s had a hand in almost all IR codes that have been developed since 1997.
“I took the first bundled IR code through the process, with TIPS being the first targeted service that was pushed to be bundled,” she said. “Getting the methodology correct for the bundling was important. Bundling was being mandated by national policy changes, and we developed a rationale for when to bundle, as well as a rationale to argue against bundling for some services.”
Dr. Krol also was part of the first multi-specialty collaborations, writing proposals for the first endograft codes alongside vascular surgery and cardiology. “That collaboration was important at a time when the specialties were very adversarial,” said Dr. Krol.
2009
“Accomplishing collaboration is one of the things I feel especially good about, as it was not easy, but was the only way to be successful.”
Following those codes, the lower extremity revascularization and carotid stenting codes were also pushed through with a collaborative effort led by SIR. Many of the code changes that occurred during Dr. Krol’s tenure are still in place, though some have been modified as technology advanced— such as codes for embolization, uterine fibroid embolization and dialysis access interventions.
“The House of Radiology has a very strong team and well-respected position at the AMA CPT and RUC meetings, with a long (some would say longest) history in the coding space,” said Julie Bulman, MD, RPVI, the current alternate advisor for SIR to the AMA CPT® Editorial Panel. “Being part of this collaborative family is a strong position for SIR to be in so that we can build new codes effectively and efficiently in our rapidly changing field.”
No need to wonder if you’re coding correctly. Check out the Coding Q&A column, developed by the Coding Application and Guidance Workgroup and published quarterly in IRQ. Visit
irq.sirweb.org/topics/coding-q-a.
Proposing, valuing and editing codes is an arduous process, one that relies on substantial work from SIR’s economics division staff and member volunteers.
2010 Primary specialty; the RFS Section
Proposal for a primary certificate in IR and DR is approved by the American Board of Medical Specialties (ABMS). It includes 35 months of DR training, one month of ICU experience, and up to 24 months of IR. Concurrently, the Resident, Fellow and Student (RFS) Section is created to promote the clinical paradigm of interventional radiology practice among students and IRs-in-training.
irq.sirweb.org | 27 2011
“This is the one area where no one else is going to do this for us. American College of Radiology (ACR) has a large and strong economics section, but their main focus is diagnostic radiology. In questions of policy that affect IR, other specialties can only support IR when the issue also supports DR or their main constituencies,” she said. “SIR has had to fight some of these battles alone.”
Representation and involvement in the coding and valuation space is as essential today as it was in the early days of IR, according to Dr. Bulman. “Given the complexity of IR’s minimally invasive techniques, active participation helps avoid misclassification, under- coding and inadequate valuation, which could hinder the financial sustainability of our field and access for our patients to these essential procedures,” she said. “Additionally, IR engagement promotes recognition of the specialty’s contributions and supports compliance with evolving healthcare policies.”
Every day, members benefit from the work put in by economics staff and volunteers, Dr. Krol said—and she encourages all members who want to make a change to get involved.
“Joining the SIR Economics Committee was a way for me to fight back,” she said. “Instead of being frustrated about what was happening to payments in IR, we actually have the power to influence payments and policy.”
2012
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
