SpineLine Medical Editor
University of Colorado School of
NASS Working For You
This edition’s column is going to be a littledifferent. Usually, thistimeof year
I’m thinking of spring, baseball, renewal,
new hope (not Star Wars) and really looking
forward to summer. I also typically provide a brief intro to all of the main articles
in SpineLine. This edition is fantastic, and
while I don’t wish to minimize the contributions, I will direct readers to the Table
of Contents for the rundown of excellent
articles, columns and authors featured in
"NASS Working For You" has been a
highlight of past Annual meetings, with
brief (five-minute) quick-hitters about
different efforts NASS staff and volunteers
have accomplished on behalf of the general
membership. In that vein, I want to use this
column to discuss a couple of timely issues
of importance to NASS members.
The first has to do with coding and billing
issues, and is based in part on the response
surrounding the 2017 CPT coding updates
reported in the January/February issue—in
particular, for spinal interbody biomechanical cages and devices—which are addressed
further in this issue's Coding column).
As you may know, prior to 1993, physicians would charge patients based on usual
and customary charges. Documentation
requirements were much less onerous
than they are currently or at least since the
Current Procedural Terminology (CPT®)
1995 and 1997 requirements for office visit
billing. Everyone knows (I hope) that the
American Medical Association “owns”
CPT®, and this system is used by the Centers
for Medicare and Medicaid Services (CMS)
and other insurance providers.
I want to clarify the role NASS has in
coding and billing, and the CPT® process.
First and foremost, it is not true that NASS
decreases reimbursement for procedures.
In the most simple terms, the process is
generally as follows:
1. An existing code is identified (usually by
CMS) for review. There can be several
a. A code has high volume or has expe-
rienced significant growth in volume
b. A code has high overall expenditures
2. The AMA CPT® Panel reviews the code
a. NASS has Advisors who work with this
panel: William Mitchell, MD, David
O'Brien Jr, MD and Don Moore, MD.
b. The Panel may recommend a CPT®
Assistant article or other clarification.
c. The Panel may recommend a new
d. The Panel may recommend the same
code with need for a new survey to
review the code's value.
3. AMA's Relative Value Unit (RVU) Update
Committee (RUC) becomes involved.
a. NASS also has advisors to this committee: Karin Swartz, MD, Kano
Mayer, MD and Charles Mick, MD.
b. NASS members (again, wearing a
different hat) may be involved as advisors but representing other organizations. A long time ago, I did this for the
American Academy of PM&R, even
though I was also a NASS member.
When I was NASS RUC Advisor, I was
no longer Advisor for AAPM&R.
c. RUC surveys are typically multi-organizational. For example, spine
injection codes included NASS as well
as PM&R, anesthesia, interventional
radiology and other multispecialty
societies working together.