News Items

Update from the Healthcare Economics Committee: Current issues in Coding and Reimbursement

CMS Coding Update 2023
  • Only 2% cut in Medicare payment 
    • 8.5% Medicare cut averted with year-end legislation
  • Telehealth extended through 2024
    • Current codes for provision of telehealth service will remain unchanged this year
  • Update to E/M codes
    • Change documentation requirements and use Medical Decision Making or Total Time the day of service to determine level of service 
    • When using total time and the time exceeds the highest-level code - a prolonged services code can be added
    • Initial Inpatient/Observation codes (99221-3)   
      • *Note:  observation visits to use these codes as all observation specific codes have been deleted
    • Subsequent Inpatient/Observation codes (99231-3)
    • Same day observation/discharge codes (99234-6)
    • Inpatient consultation codes (99252-5)
    • Outpatient consultation codes (99242-5)
  • New abdominal wall hernia codes any method (open, laparoscopic, robotic) based on size, reducible/incarcerated and initial/recurrent
    • The new codes have zero-day global period so all preop visits and postoperative visits are billable using outpatient or inpatient E/M visit codes
    • Mesh placement is included in the new hernia codes
    • If you are removing the mesh, there is a new code for removal
    • All abdominal wall hernia types are included: epigastric, ventral, umbilical and parastomal  
    • Inguinal, femoral and lumbar hernias are excluded from this change

ACS and ASCRS Brandeis Leadership in Health Policy Scholarship

The American College of Surgeons (ACS) and the American Society of Colon and Rectal Surgeons (ASCRS) are supporting the annual health policy scholarship to attend the Executive Leadership Program in Health Policy and Management. The scholarship is a unique opportunity to learn more about health care delivery, policy and reform.

Open to members of ASCRS and ACS residing in the United States, the scholarship supports attendance to the Executive Leadership Program in Health Policy and Management at Brandeis University, June 3-8, 2024. The recipient will receive $8,000 to be used toward the cost of tuition, travel, housing, and subsistence during the program.

Applicants must be members in good standing of both organizations and be between 30 and 60 years of age. Specific requirements for the Health Policy Scholarship are available on the ACS website. The deadline for receipt of all application materials is March 15, 2024. All applicants will be notified of the outcome of the selection process in May 2024.

Applications should be submitted online here.

Questions may be directed to the ACS Scholarships Administrator at 312-202-5281 or [email protected].

ASCRS Announces Premier Sponsor agreement with Cook Biotech


Cook Biotech Incorporated has joined The American Society of Colon and Rectal Surgeons (ASCRS) as one of its inaugural Premier Sponsors, a program that represents the highest-level opportunity for companies to differentiate themselves and support their strategic interest to ASCRS members and audiences. Premier Sponsors receive year-round recognition and premium positioning as part of the exclusive sponsorship.

“Premier Sponsors are the evolution of our Society and core industry partners working together at a strategic level. ASCRS appreciates Cook Biotech’s support and looks forward to a long and fruitful relationship,” said Conor Delaney, MD, PhD, ASCRS President.

ASCRS Executive Director David Westman, CPA, CAE stated, “We’re excited for Cook Biotech to join the ASCRS Premier Sponsor program as a charter member. The combined interest of our two organizations will surely do great things for the specialty in the years to come.”

Cook Biotech President Umesh Patel said, “We are proud to support ASCRS and its mission to advance the field of colorectal surgery. Cook Biotech is committed to providing support for clinicians and improving outcomes for patients. We look forward to our unique partnership with ASCRS as we work together to achieve these objectives.”

Learn more about the Premier Sponsorship here.

For further information about Premier Sponsorships, contact Jason Keith, Sr. Director, Corporate Relations | Marketing and Communications at [email protected].

About Cook Biotech
Cook Biotech, a Cook Group company, has been a leader in regenerative medicine for over 25 years. We develop transformative advanced tissue-repair products that improve patient outcomes worldwide. Our products are derived from naturally occurring extracellular matrices with wide-ranging indications including hernia, soft tissue defects, rectopexy, wound care, and fistula.

About The American Society of Colon and Rectal Surgeons
The American Society of Colon and Rectal Surgeons is a professional society for healthcare providers specializing in colorectal surgery. ASCRS is dedicated to ensuring high-quality patient care by advancing the science, prevention and management of disorders and diseases of the colon, rectum and anus.

UPDATE from the ASCRS Healthcare Economics Committee

ASCRS participation at the AMA House of Delegates (HOD)November 2022 Interim Meeting
ASCRS  Delegates: Anne Mongiu M.D. and Lucas Poggio M.D.
ASCRS Alternate Delegates: Paul Johnson M.D., Sachin Vaid M.D.
House of Delegates Facts:
  • The HOD is the legislative body of the American Medical Association (AMA)
  • Delegates represent state medical societies, various subspecialty societies and government
  • Delegate count is based upon the number of AMA members within each state/society – ASCRS has 2 Delegates and 2 Alternate Delegates
  • ASCRS Delegates are part of the Digestive Disease Section Council (DDSC)1
  • The House of Delegates (HOD) meets twice a year to introduce and debate new resolutions which can become AMA advocacy policy, as well as modify and (re)affirm existing AMA policy
  • Resolutions are grouped into “reference committees”2 by subject matter to facilitate further review and deliberation
  • Resolutions for new advocacy and modifications to existing AMA policy are introduced a few weeks in advance of each meeting to a public website where it can be reviewed and commented on in an open forum by AMA members and member societies 
  • Prior to the start of business of the annual meeting, the reference committees summarize all the testimony offered in the open forum
  • The first portion of the meeting itself, then involves labor-intensive review of each resolution line by line with open testimony on the floor of the HOD
  • The reference committees carefully summarize all the testimony given and adjust/amend the resolutions to match the will of the house as testified
  • The entire house meets as a whole after review the reference committees work, and vote either to accept the judgement the reference committee or to bring individual items are parts of items to the floor of the house for open to be voting
  • At the end of the meeting all proffered resolutions are accepted, amended, overruled, or referred for further study/decision
November 2022 Meeting Update:
Prior to the meeting, ASCRS delegates and alternate delegates vet all proffered resolutions and identified 20 (of > 100 proffered) that would be most relevant to Colorectal surgeons and their patients.
Day 1: Activities at the Digestive Disease Section Council (DDSC):
The ASCRS received DDSC support for:
  • Resolution 819: advocating for the implementation of updated US preventative services task force recommendations for colorectal cancer screening among primary care physicians in major payers by the AMA
  • Resolution 817: promoting oral anticancer drug parity
  • Resolution 808: Reinstatement of consultation codes
  • Resolution B201: Physician reimbursement for interpreter services
The ASCRS received partial support from some DDSC members but not the full backing of the Council:
  • Resolutions 310 and 316: AMA backing of certifying/recertifying organizations
Day 2:  Reference committees systematically review resolutions and hear oral testimony3
Dr. Poggio: gave oral testimony on items J817, J819, C31
Dr. Mongiu: served as a member of Reference Committee J hearing all resolutions

Day 3 and 4: Debate on the resolutions proffered by the Reference Committees1:
The Caucasus, Councils, and subspecialty societies subsequently meet on Monday morning to review the final resolutions proffered by the reference committees, identifying those with which they agreed, and those on which they would elect to call out for further debate on the floor.

Reference Committee J:
Resolution 816: Supporting coverage of continuous glucose monitoring devices for patients with diabetes - Adopted
Resolutions 817: Promoting oral anti-cancer drug coverage parity – Adopted after testimony and amendment
Resolution 819: Advocating implementation, education, and coverage of USPSTF colorectal cancer screening guidelines - Adopted after testimony and reference committee amendment reaffirmed Resolution  808: Reinstatement consultation codes – Reaffirmed with stronger language
Resolution 810: Concerning transparent negotiations for Medicare drug pricing, patent evergreening, and blocking direct to consumer advertising – Reaffirmed with stronger language
Reference Committee B:
Resolution 201: Reimbursement for interpreter services, expanded to include ASL -Adopted and amended
Resolution 205: Supporting elimination of waiver of due process clause is from physician contracts – Adopted and amended
Resolution 223: Broadening the AMA stance against criminalization a pregnancy loss as a result of medical treatment (such as treatment for colon cancer) – Adopted and amended
Resolution 224:  Providing insurance coverage for fertility treatment, especially in the case of iatrogenic infertility (such as IPAA) -Adopted and amended
Reference Committee C:
CME 1: Impact of private equity
  • Recommended for adoption and supported by the ASCRS delegates
  • This is very important for our society. Investment by PE (private equity) in health care is increasing and can affect training programs
  • Example: The closed Philadelphia Hahnemann University Training Program in 2019 required significant efforts from ACGME and AMA to ensure trainees were able to continue with their training despite needing to change institutions
CME 2: Mitigating demographic and socioeconomic inequities in the Residency and Fellowship selection process
  • Recommended for adoption and supported by the ASCRS delegates
Resolution C302/303 and 308: Address employee leave to include miscarriage and stillbirth along with medical student leave and paid family/medical leave in medicine
  • Amended and significant changes were implemented and adopted
  • Asking for a study of the feasibility of incorporating into their parental leave policies for a 12-week minimum leave allowance
  • Supported by the ASCRS: it addresses parental, family and medical necessity leave for medical students and physicians
Resolution C305: Addresses the need to encourage medical schools to sponsor pipeline programs to Medicine for underrepresented groups had significant changes but essentially encouraged in resolution that medical schools recommend pathways programs for underrepresented students free of charge for example. And it was supported by us.
Resolution C316: Modifying existing AMA policy to have stronger language supporting specialty certification to include boards which both certify and recertify, rather than those who offer to recertify physician previously certified elsewhere
  • Spirited debate on the floor with a split result 
  • A portion of the amended language was accepted and the stronger verbiage was moved for referral back to the reference committee for further review
  • Some Societies voiced resistance to current ABMS recertification citing physician "burn out" and "cost"
  • The specialty certification issue will likely continue to arise at future meetings with need for continued work on the part of the ABMS and Specialty Societies/ASCRS to advocate for
Reference Committee K:
Resolution K902: Addresses recommendations to reduce the burden of incarceration on Public Health
  • Supported by ASCRS delegates and recommended for adoption with amendments
  • These amendments include but are not limited to address the need for a livable wage and access to affordable housing opportunities - these issues often impact successfully returning into society.
Resolution K916: ASCRS provided oral testimony for expanding HPV associated cancer prevention from cervical cancer to include specific language which relates to our work in screening patients for HPV-related anal cancer including but not limited to patients with anal dysplasia and anal cancer secondary to HPV infection
1. The DDSC is comprised of delegates from the American College of Gastroenterology, American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, Society of American Gastrointestinal Endoscopic Surgeons, ASCRS, and American Society for Metabolic and Bariatric Surgery, and comprises ~20 delegates. The Chair of the DDSC is rotated between the medical and surgical societies. ASCRS will be chair during the 2025/26 meeting season. The benefit of DDSC backing on resolutions means the voice of our two-delegate society is amplified to include the entire membership of the DDSC when giving oral testimony in the HOD. Testimony delivered on behalf of section counsel carries more weight than an individual or small society in the ultimate decision making performed by the reference committee.
2. The subject matter referred to each reference committee is as follows:
● Reference Committee on Amendments to Constitution and Bylaws (Constitution;
Bylaws; Ethics)
● Reference Committee A: Medical Service (Annual Meeting only)
● Reference Committee B: Legislation
● Reference Committee C: Medical Education (Annual Meeting only)
● Reference Committee D: Public Health (Annual Meeting only)
● Reference Committee E: Science and Technology (Annual Meeting only)
● Reference Committee F: AMA Finance and Governance
● Reference Committee G: Medical Practice (Annual Meeting only)
● Reference Committee J: Advocacy related to medical service, medical practice, insurance
and related topics (Interim Meeting only)
● Reference Committee K: Advocacy related to medical education, science and public
health and related topics (Interim Meeting only)
3. At the end of the day, the delegates are dismissed, and the reference committee members spend the evening reviewing the testimony and writing/rewriting the resolutions to match the spoken testimony and submit

ASCRS Response to the NordICC Study

As the American Society of Colon and Rectal Surgeons, it is our mission to advance the understanding, prevention and treatment of colorectal cancer.  Colorectal surgeons are uniquely involved in every aspect of colon cancer care including prevention, diagnosis, treatment, and surveillance.  
The findings of the recent NordICC study, published in the New England Journal of Medicine, have generated significant media attention, calling into question the benefit of screening colonoscopy in preventing colorectal cancer.  It is vitally important to us to clarify the findings of the study to avoid misinterpretation.

The NordICC study enrolled over 84,000 patients in Poland, Norway, and Sweden, and randomized them to either receive an invitation to undergo screening colonoscopy, or to follow usual care.  Strikingly, only 42% of the invited patients actually underwent colonoscopy, and this significantly diluted the benefits of colonoscopy in the study.  While the group invited to undergo colonoscopy had an 18% reduction in the risk of colorectal cancer after a decade of follow-up, there was no difference in the two groups with regard to risk of death from colorectal cancer (0.25% vs. 0.31%).  Importantly, the investigators calculated that, had all invited patients undergone the screening colonoscopy, they would have had a 30% reduction in the risk of colorectal cancer and 50% reduction in the risk of death due to colorectal cancer. 

Therefore, based on the findings of this study and many others, the ASCRS still recommends screening colonoscopy beginning at age 45 for average risk patients, in accordance with the American Cancer Society guidelines.  Colonoscopy is the most effective test to prevent, diagnose and reduce the incidence of colorectal cancer.  Patients may also consider alternatives to screening colonoscopy after discussing with their primary care physician.  Options include flexible sigmoidoscopy, CT colonography (“virtual colonoscopy”), as well as stool-based tests such as the fecal immunochemical test (FIT), fecal occult blood test, and fecal DNA tests.  The ASCRS is committed to improving access to colonoscopy and awareness of alternative screening options in order to have the greatest impact on prevention of colorectal cancer.
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