Читать книгу Leksell Radiosurgery - Группа авторов - Страница 34

Any new technology requires two main attributes: patient benefit (medical merit) and fiscal responsibility. Radiosurgery is a cost-saving modality devoid of high per minute operating room charges, intensive care units, or hospital admissions. As an FDA-approved technology, medical coding was established early by the Center for Medicare and Medicaid (CMS) in 1987. Many other commercial and eventually HMO insurance plans slowly followed suit. The original patients were treated as inpatients and covered under DRG 1 (a surgical code covering craniotomy as well). Over the years, various insurance companies have fought, denied, and eventually acquiesced (periodically) in the reimbursement of both hospital (Part A) and physician (Part B) charges. The development of the Ambulatory Payment Classification (APC) strategy led most hospitals to switch to outpatient radiosurgery. The billing codes submitted to the CMS for radiosurgery exceeded the number submitted for craniotomy in 1997 (Fig. 5). As sufficient growth and attention to the field emerged, negotiations between the American Association of Neurological surgeons (AANS) and the American Society of Therapeutic Radiation Oncology (ASTRO) led to an agreement that neurosurgical care would be covered under the 6-series coding of the AMA CPT code system, whereas radiation oncology services would be coded using the 7-series codes. Most reimbursement insurance vehicles are still confused by radiosurgery, supplemented by turf war statements of radiosurgery as surgery or radiosurgery as radiation therapy. The International Radiosurgery Association headed by Rebecca Emerick has been very helpful in working for clarification with insurance companies and the CMS.

Fig. 5. The increasing role of Gamma Knife radiosurgery was confirmed when the SRS surgical codes exceeded those submitted for craniotomy in the Medicare population in 2003. In 2009 a revision of the coding system led to fewer submitted codes, but still exceeded those submitted for craniotomy.