Society News

In a significant victory for patients and healthcare providers, Blue Cross Blue Shield of Massachusetts (BCBSMA) has officially postponed its restrictive anesthesia policy until further notice. The change is retroactive to Jan. 1, 2024, so no claims will be rejected for payment.

The decision follows intense advocacy efforts by a coalition that included AGA, the American Society of Anesthesiologists (ASA), and the American College of Surgeons (ACS), with the Massachusetts Gastroenterology Association demonstrating exceptional leadership and the Massachusetts Society of Anesthesiologists (MSA) persevering throughout the process. The BCBSMA heeded the coalition’s warnings about the potential impact on cancer screening access and patient choice in GI care.

Physician leaders representing the societies played a crucial role in meetings with BCBSMA, contributing to this positive outcome. Member engagement, including contacting legislators, media outreach, and participation in the #Noto154 campaign, had a substantial impact.

BCBSMA informed the societies that all claims will be paid; however, documentation will still be required for patients presenting with ASA 1 and ASA 2. Providers may download a list of commonly used diagnosis codes documented with the administration of propofol. The AGA encourages members to still be mindful that BCBSMA will be monitoring the use of these codes for propofol administration. Members can see BCBSMA policy 154 for the complete list of diagnosis codes that support use of MAC. The societies have requested that BCBSMA provide education to providers on this requirement.

The AGA intends to closely monitor developments to ensure similar policies are not introduced nationally.

In a significant victory for patients and healthcare providers, Blue Cross Blue Shield of Massachusetts (BCBSMA) has officially postponed its restrictive anesthesia policy until further notice. The change is retroactive to Jan. 1, 2024, so no claims will be rejected for payment.

The decision follows intense advocacy efforts by a coalition that included AGA, the American Society of Anesthesiologists (ASA), and the American College of Surgeons (ACS), with the Massachusetts Gastroenterology Association demonstrating exceptional leadership and the Massachusetts Society of Anesthesiologists (MSA) persevering throughout the process. The BCBSMA heeded the coalition’s warnings about the potential impact on cancer screening access and patient choice in GI care.

Physician leaders representing the societies played a crucial role in meetings with BCBSMA, contributing to this positive outcome. Member engagement, including contacting legislators, media outreach, and participation in the #Noto154 campaign, had a substantial impact.

BCBSMA informed the societies that all claims will be paid; however, documentation will still be required for patients presenting with ASA 1 and ASA 2. Providers may download a list of commonly used diagnosis codes documented with the administration of propofol. The AGA encourages members to still be mindful that BCBSMA will be monitoring the use of these codes for propofol administration. Members can see BCBSMA policy 154 for the complete list of diagnosis codes that support use of MAC. The societies have requested that BCBSMA provide education to providers on this requirement.

The AGA intends to closely monitor developments to ensure similar policies are not introduced nationally.

In a significant victory for patients and healthcare providers, Blue Cross Blue Shield of Massachusetts (BCBSMA) has officially postponed its restrictive anesthesia policy until further notice. The change is retroactive to Jan. 1, 2024, so no claims will be rejected for payment.

The decision follows intense advocacy efforts by a coalition that included AGA, the American Society of Anesthesiologists (ASA), and the American College of Surgeons (ACS), with the Massachusetts Gastroenterology Association demonstrating exceptional leadership and the Massachusetts Society of Anesthesiologists (MSA) persevering throughout the process. The BCBSMA heeded the coalition’s warnings about the potential impact on cancer screening access and patient choice in GI care.

Physician leaders representing the societies played a crucial role in meetings with BCBSMA, contributing to this positive outcome. Member engagement, including contacting legislators, media outreach, and participation in the #Noto154 campaign, had a substantial impact.

BCBSMA informed the societies that all claims will be paid; however, documentation will still be required for patients presenting with ASA 1 and ASA 2. Providers may download a list of commonly used diagnosis codes documented with the administration of propofol. The AGA encourages members to still be mindful that BCBSMA will be monitoring the use of these codes for propofol administration. Members can see BCBSMA policy 154 for the complete list of diagnosis codes that support use of MAC. The societies have requested that BCBSMA provide education to providers on this requirement.

The AGA intends to closely monitor developments to ensure similar policies are not introduced nationally.

The American Gastroenterological Association (AGA) has published a clinical practice update on polypectomy techniques.

The new guidance document, authored by Andrew P. Copland, MD, of the University of Virginia Health System, Charlottesville, and colleagues, includes 12 pieces of best practice advice pertaining to polyp removal, including the need for evaluation, considerations for selecting a resection strategy, and reasons for referral.

“Polypectomy techniques are continually evolving with improvements in the ability to assess polyps for high-risk features and with development of appropriate procedures for complete and safe polyp resection,” the authors wrote in Clinical Gastroenterology and Hepatology. “This clinical practice update provides guidance in characterizing polyps and choosing appropriate polypectomy techniques for polyps 2 cm or less in size, which comprise most polyps encountered by most endoscopists.”

UVA Health

To begin, they advised a “structured visual assessment using high-definition white light and/or electronic chromoendoscopy and with photodocumentation” for all polyps identified during routine colonoscopy, with close attention to any features suggesting submucosal invasion.

Next, in a series of statements, the guidance document steers appropriate use of various cold and hot polypectomy techniques.

Cold snare polypectomy should be used for polyps less than 10 mm in size, while cold forceps may be considered for polyps 1-3 mm in diameter. Cold resection techniques should also be used for serrated polyps, with use of submucosal injection, if needed, for polyps greater than 10 mm with unclear margins.

For polyps of intermediate size (10-19 mm), both cold and hot snare polypectomy should be considered, alongside endoscopic mucosal resection for polyps, Dr. Copland and colleagues wrote, noting that hot snare polypectomy should be used for removal of pedunculated lesions greater than 10 mm in size.

In contrast, the update advises against use of hot forceps polypectomy in any scenario.

“Hot forceps polypectomy for diminutive and small polyps is associated with higher incomplete polyp removal rates compared with cold snare polypectomy,” the update panelists wrote. “It is also associated with higher risks of postpolypectomy hemorrhage, particularly in the right colon with higher risks of deep thermal injury. Therefore, the use of hot forceps polypectomy is discouraged.”

In another best practice advice statement, the panelists advised against routine use of clips to close resection sites for polyps less than 20 mm. For larger polyps, they advised “selective use” of clips, most suitably in the proximal colon.

Alternatively, patients with polyps at least 20 mm in size should be considered for referral to endoscopic referral centers, along with patients who have polyps in “challenging” locations, and those with a recurrent polyp at a prior polypectomy site.

Patients with nonpedunculated polyps that exhibit “clear evidence of submucosally invasive cancer” should be referred for surgical evaluation, they added. On a similar note, the update advises tattooing lesions that may need to be located at a future surgery or endoscopy.

Finally, Dr. Copland and colleagues advised all endoscopists to understand appropriate selection of electrosurgical generator settings for various polypectomy or postpolypectomy thermal techniques.

“Ongoing research will allow further tailoring of polypectomy techniques to improve patient outcomes,” they concluded.This clinical practice update was commissioned and approved by the AGA Institute. The working group disclosed relationships with Olympus, Boston Scientific, GIE Medical, and others.

The American Gastroenterological Association (AGA) has published a clinical practice update on polypectomy techniques.

The new guidance document, authored by Andrew P. Copland, MD, of the University of Virginia Health System, Charlottesville, and colleagues, includes 12 pieces of best practice advice pertaining to polyp removal, including the need for evaluation, considerations for selecting a resection strategy, and reasons for referral.

“Polypectomy techniques are continually evolving with improvements in the ability to assess polyps for high-risk features and with development of appropriate procedures for complete and safe polyp resection,” the authors wrote in Clinical Gastroenterology and Hepatology. “This clinical practice update provides guidance in characterizing polyps and choosing appropriate polypectomy techniques for polyps 2 cm or less in size, which comprise most polyps encountered by most endoscopists.”

UVA Health

To begin, they advised a “structured visual assessment using high-definition white light and/or electronic chromoendoscopy and with photodocumentation” for all polyps identified during routine colonoscopy, with close attention to any features suggesting submucosal invasion.

Next, in a series of statements, the guidance document steers appropriate use of various cold and hot polypectomy techniques.

Cold snare polypectomy should be used for polyps less than 10 mm in size, while cold forceps may be considered for polyps 1-3 mm in diameter. Cold resection techniques should also be used for serrated polyps, with use of submucosal injection, if needed, for polyps greater than 10 mm with unclear margins.

For polyps of intermediate size (10-19 mm), both cold and hot snare polypectomy should be considered, alongside endoscopic mucosal resection for polyps, Dr. Copland and colleagues wrote, noting that hot snare polypectomy should be used for removal of pedunculated lesions greater than 10 mm in size.

In contrast, the update advises against use of hot forceps polypectomy in any scenario.

“Hot forceps polypectomy for diminutive and small polyps is associated with higher incomplete polyp removal rates compared with cold snare polypectomy,” the update panelists wrote. “It is also associated with higher risks of postpolypectomy hemorrhage, particularly in the right colon with higher risks of deep thermal injury. Therefore, the use of hot forceps polypectomy is discouraged.”

In another best practice advice statement, the panelists advised against routine use of clips to close resection sites for polyps less than 20 mm. For larger polyps, they advised “selective use” of clips, most suitably in the proximal colon.

Alternatively, patients with polyps at least 20 mm in size should be considered for referral to endoscopic referral centers, along with patients who have polyps in “challenging” locations, and those with a recurrent polyp at a prior polypectomy site.

Patients with nonpedunculated polyps that exhibit “clear evidence of submucosally invasive cancer” should be referred for surgical evaluation, they added. On a similar note, the update advises tattooing lesions that may need to be located at a future surgery or endoscopy.

Finally, Dr. Copland and colleagues advised all endoscopists to understand appropriate selection of electrosurgical generator settings for various polypectomy or postpolypectomy thermal techniques.

“Ongoing research will allow further tailoring of polypectomy techniques to improve patient outcomes,” they concluded.This clinical practice update was commissioned and approved by the AGA Institute. The working group disclosed relationships with Olympus, Boston Scientific, GIE Medical, and others.

The American Gastroenterological Association (AGA) has published a clinical practice update on polypectomy techniques.

The new guidance document, authored by Andrew P. Copland, MD, of the University of Virginia Health System, Charlottesville, and colleagues, includes 12 pieces of best practice advice pertaining to polyp removal, including the need for evaluation, considerations for selecting a resection strategy, and reasons for referral.

“Polypectomy techniques are continually evolving with improvements in the ability to assess polyps for high-risk features and with development of appropriate procedures for complete and safe polyp resection,” the authors wrote in Clinical Gastroenterology and Hepatology. “This clinical practice update provides guidance in characterizing polyps and choosing appropriate polypectomy techniques for polyps 2 cm or less in size, which comprise most polyps encountered by most endoscopists.”

UVA Health

To begin, they advised a “structured visual assessment using high-definition white light and/or electronic chromoendoscopy and with photodocumentation” for all polyps identified during routine colonoscopy, with close attention to any features suggesting submucosal invasion.

Next, in a series of statements, the guidance document steers appropriate use of various cold and hot polypectomy techniques.

Cold snare polypectomy should be used for polyps less than 10 mm in size, while cold forceps may be considered for polyps 1-3 mm in diameter. Cold resection techniques should also be used for serrated polyps, with use of submucosal injection, if needed, for polyps greater than 10 mm with unclear margins.

For polyps of intermediate size (10-19 mm), both cold and hot snare polypectomy should be considered, alongside endoscopic mucosal resection for polyps, Dr. Copland and colleagues wrote, noting that hot snare polypectomy should be used for removal of pedunculated lesions greater than 10 mm in size.

In contrast, the update advises against use of hot forceps polypectomy in any scenario.

“Hot forceps polypectomy for diminutive and small polyps is associated with higher incomplete polyp removal rates compared with cold snare polypectomy,” the update panelists wrote. “It is also associated with higher risks of postpolypectomy hemorrhage, particularly in the right colon with higher risks of deep thermal injury. Therefore, the use of hot forceps polypectomy is discouraged.”

In another best practice advice statement, the panelists advised against routine use of clips to close resection sites for polyps less than 20 mm. For larger polyps, they advised “selective use” of clips, most suitably in the proximal colon.

Alternatively, patients with polyps at least 20 mm in size should be considered for referral to endoscopic referral centers, along with patients who have polyps in “challenging” locations, and those with a recurrent polyp at a prior polypectomy site.

Patients with nonpedunculated polyps that exhibit “clear evidence of submucosally invasive cancer” should be referred for surgical evaluation, they added. On a similar note, the update advises tattooing lesions that may need to be located at a future surgery or endoscopy.

Finally, Dr. Copland and colleagues advised all endoscopists to understand appropriate selection of electrosurgical generator settings for various polypectomy or postpolypectomy thermal techniques.

“Ongoing research will allow further tailoring of polypectomy techniques to improve patient outcomes,” they concluded.This clinical practice update was commissioned and approved by the AGA Institute. The working group disclosed relationships with Olympus, Boston Scientific, GIE Medical, and others.

The AGA Research Foundation plays an important role in medical research by providing grants to young scientists at a critical time in their career. AGA’s flagship award is the Research Scholar Award, which provides career development support for young investigators in gastroenterology and hepatology research. In the last 10 years, the AGA Research Foundation has funded 63 young scientists through a Research Scholar Award grant.

“I want to express my sincere gratitude to the AGA Research Foundation and its benefactors. At this fragile and critical juncture, this AGA Research Scholar Award offers an unmatched opportunity to pursue the type of high-impact scientific work that allows a junior investigator such as myself to achieve the necessary momentum to create a nationally competitive research program,” states Alexander , MD, PhD, the Regent of the University of California, Los Angeles, 2023 AGA Research Scholar Award recipient.

Funded by the generosity of donors, the AGA Research Foundation’s research award program ensures that we are building a community of researchers whose work serves the greater community and benefits all our patients.

By joining others in supporting the AGA Research Foundation, you will ensure that young researchers have opportunities to continue their life-saving work. Your tax-deductible contribution supports the foundation’s research award program, including the Research Scholar Award, which ensures that studies are funded, discoveries are made, and patients are treated. Learn more or make a contribution at www.foundation.gastro.org.

The AGA Research Foundation plays an important role in medical research by providing grants to young scientists at a critical time in their career. AGA’s flagship award is the Research Scholar Award, which provides career development support for young investigators in gastroenterology and hepatology research. In the last 10 years, the AGA Research Foundation has funded 63 young scientists through a Research Scholar Award grant.

“I want to express my sincere gratitude to the AGA Research Foundation and its benefactors. At this fragile and critical juncture, this AGA Research Scholar Award offers an unmatched opportunity to pursue the type of high-impact scientific work that allows a junior investigator such as myself to achieve the necessary momentum to create a nationally competitive research program,” states Alexander , MD, PhD, the Regent of the University of California, Los Angeles, 2023 AGA Research Scholar Award recipient.

Funded by the generosity of donors, the AGA Research Foundation’s research award program ensures that we are building a community of researchers whose work serves the greater community and benefits all our patients.

By joining others in supporting the AGA Research Foundation, you will ensure that young researchers have opportunities to continue their life-saving work. Your tax-deductible contribution supports the foundation’s research award program, including the Research Scholar Award, which ensures that studies are funded, discoveries are made, and patients are treated. Learn more or make a contribution at www.foundation.gastro.org.

The AGA Research Foundation plays an important role in medical research by providing grants to young scientists at a critical time in their career. AGA’s flagship award is the Research Scholar Award, which provides career development support for young investigators in gastroenterology and hepatology research. In the last 10 years, the AGA Research Foundation has funded 63 young scientists through a Research Scholar Award grant.

“I want to express my sincere gratitude to the AGA Research Foundation and its benefactors. At this fragile and critical juncture, this AGA Research Scholar Award offers an unmatched opportunity to pursue the type of high-impact scientific work that allows a junior investigator such as myself to achieve the necessary momentum to create a nationally competitive research program,” states Alexander , MD, PhD, the Regent of the University of California, Los Angeles, 2023 AGA Research Scholar Award recipient.

Funded by the generosity of donors, the AGA Research Foundation’s research award program ensures that we are building a community of researchers whose work serves the greater community and benefits all our patients.

By joining others in supporting the AGA Research Foundation, you will ensure that young researchers have opportunities to continue their life-saving work. Your tax-deductible contribution supports the foundation’s research award program, including the Research Scholar Award, which ensures that studies are funded, discoveries are made, and patients are treated. Learn more or make a contribution at www.foundation.gastro.org.

According to a rule issued by CMS, starting in 2026, health plans must decide on prior authorization requests within 72 hours for an expedited request or 7 days for non-urgent appeals.

The rule also requires plans to provide a detailed rationale for a denial and include metrics on denials and approvals.

AGA and our allies in the physician community have aggressively advocated that Congress and the Administration address prior auth, which slows patient access to care and contributes to physician burnout.

The rule applies to Medicare, Medicare Advantage (MA), Medicaid, Children’s Health Insurance Plans (CHIP), and qualified health plans on the exchange.

Thank you to our advocates who called on policymakers to take action to ensure patients receive care in a timely manner.

According to a rule issued by CMS, starting in 2026, health plans must decide on prior authorization requests within 72 hours for an expedited request or 7 days for non-urgent appeals.

The rule also requires plans to provide a detailed rationale for a denial and include metrics on denials and approvals.

AGA and our allies in the physician community have aggressively advocated that Congress and the Administration address prior auth, which slows patient access to care and contributes to physician burnout.

The rule applies to Medicare, Medicare Advantage (MA), Medicaid, Children’s Health Insurance Plans (CHIP), and qualified health plans on the exchange.

Thank you to our advocates who called on policymakers to take action to ensure patients receive care in a timely manner.

According to a rule issued by CMS, starting in 2026, health plans must decide on prior authorization requests within 72 hours for an expedited request or 7 days for non-urgent appeals.

The rule also requires plans to provide a detailed rationale for a denial and include metrics on denials and approvals.

AGA and our allies in the physician community have aggressively advocated that Congress and the Administration address prior auth, which slows patient access to care and contributes to physician burnout.

The rule applies to Medicare, Medicare Advantage (MA), Medicaid, Children’s Health Insurance Plans (CHIP), and qualified health plans on the exchange.

Thank you to our advocates who called on policymakers to take action to ensure patients receive care in a timely manner.

As the number of women in gastroenterology grows, so does AGA’s portfolio of programs focused on maximizing the role of women in GI.

“Women continue to face unique barriers to leadership including gender bias, lack of role models, maternal discrimination, and lack of equal consideration for opportunities,” notes AGA President Barbara Jung, MD, AGAF. “AGA sits in a unique position where we can influence changes in academia and practice to improve the field for all women and particularly enhance women leaders.”

A tangible way AGA supports female leadership and career advancement is the Women in GI Regional Workshops. Throughout 2024, these workshops provide opportunities for networking, business and financial education training, burnout prevention strategies, and career advice.

American Gastroenterological Association

Bigger picture, AGA’s Gender Equity Framework paints a compelling vision for the future in six domains:

• Bias & gender disparities: Academic institutions, healthcare systems, and practices establish regular systems of equity reviews and eradicate institutional gender disparities and bias.
• Leadership & career advancement: Equitable access to leadership in the field and professional GI societies for the benefit of medicine, research, and patient care.
• Wellness & balance: Women in GI experience balanced integration of family, work, community, health, and professional growth.
• Retention & recruitment: GI is the leading specialty for women in medicine and a sustainable career where women grow and thrive.
• Mentorship & sponsorship: The benefits of mentorship and sponsorship are universally recognized and incentivized in GI institutions and practices.
• Recognition: Equitable recognition of the achievements and contributions of women in GI.

In the coming years, AGA committees will collaborate with the AGA Women’s Committee to achieve the vision laid out in the AGA Gender Equity Framework. Thank you to the AGA Women’s Committee, which created the framework, under the leadership of chair Aimee Lucas, MD, MS, AGAF, and within the auspices of the AGA Equity Project (gastro.org/equity).

As the number of women in gastroenterology grows, so does AGA’s portfolio of programs focused on maximizing the role of women in GI.

“Women continue to face unique barriers to leadership including gender bias, lack of role models, maternal discrimination, and lack of equal consideration for opportunities,” notes AGA President Barbara Jung, MD, AGAF. “AGA sits in a unique position where we can influence changes in academia and practice to improve the field for all women and particularly enhance women leaders.”

A tangible way AGA supports female leadership and career advancement is the Women in GI Regional Workshops. Throughout 2024, these workshops provide opportunities for networking, business and financial education training, burnout prevention strategies, and career advice.

American Gastroenterological Association

Bigger picture, AGA’s Gender Equity Framework paints a compelling vision for the future in six domains:

• Bias & gender disparities: Academic institutions, healthcare systems, and practices establish regular systems of equity reviews and eradicate institutional gender disparities and bias.
• Leadership & career advancement: Equitable access to leadership in the field and professional GI societies for the benefit of medicine, research, and patient care.
• Wellness & balance: Women in GI experience balanced integration of family, work, community, health, and professional growth.
• Retention & recruitment: GI is the leading specialty for women in medicine and a sustainable career where women grow and thrive.
• Mentorship & sponsorship: The benefits of mentorship and sponsorship are universally recognized and incentivized in GI institutions and practices.
• Recognition: Equitable recognition of the achievements and contributions of women in GI.

In the coming years, AGA committees will collaborate with the AGA Women’s Committee to achieve the vision laid out in the AGA Gender Equity Framework. Thank you to the AGA Women’s Committee, which created the framework, under the leadership of chair Aimee Lucas, MD, MS, AGAF, and within the auspices of the AGA Equity Project (gastro.org/equity).

As the number of women in gastroenterology grows, so does AGA’s portfolio of programs focused on maximizing the role of women in GI.

“Women continue to face unique barriers to leadership including gender bias, lack of role models, maternal discrimination, and lack of equal consideration for opportunities,” notes AGA President Barbara Jung, MD, AGAF. “AGA sits in a unique position where we can influence changes in academia and practice to improve the field for all women and particularly enhance women leaders.”

A tangible way AGA supports female leadership and career advancement is the Women in GI Regional Workshops. Throughout 2024, these workshops provide opportunities for networking, business and financial education training, burnout prevention strategies, and career advice.

American Gastroenterological Association

Bigger picture, AGA’s Gender Equity Framework paints a compelling vision for the future in six domains:

• Bias & gender disparities: Academic institutions, healthcare systems, and practices establish regular systems of equity reviews and eradicate institutional gender disparities and bias.
• Leadership & career advancement: Equitable access to leadership in the field and professional GI societies for the benefit of medicine, research, and patient care.
• Wellness & balance: Women in GI experience balanced integration of family, work, community, health, and professional growth.
• Retention & recruitment: GI is the leading specialty for women in medicine and a sustainable career where women grow and thrive.
• Mentorship & sponsorship: The benefits of mentorship and sponsorship are universally recognized and incentivized in GI institutions and practices.
• Recognition: Equitable recognition of the achievements and contributions of women in GI.

In the coming years, AGA committees will collaborate with the AGA Women’s Committee to achieve the vision laid out in the AGA Gender Equity Framework. Thank you to the AGA Women’s Committee, which created the framework, under the leadership of chair Aimee Lucas, MD, MS, AGAF, and within the auspices of the AGA Equity Project (gastro.org/equity).

Follow your own path to better outcomes for patients with GI diseases at Digestive Disease Week^® (DDW) 2024, the world’s largest and most comprehensive gathering of gastroenterology clinicians, researchers and industry. Registration and housing are now open, and AGA members can save up to $380 on registration fees. Discounted registration rates are also available through the March 13 early bird deadline. AGA member trainees, students, residents and postdoctoral fellows can register for free through this date. Visit ddw.org/register to join us.

This year, DDW takes place May 18-21, in Washington, D.C., and online. Whether you work in patient care, research, training or academia, you’ll find content tailored to your essential role at every step.

Add on to your DDW experience with AGA’s one-day Postgraduate Course. Join us on May 18, from D.C. or online, to explore challenging patient cases, high-impact papers, and important practice updates that you can use immediately upon your return to the clinic. Learn more at pgcourse.gastro.org.

Follow your own path to better outcomes for patients with GI diseases at Digestive Disease Week^® (DDW) 2024, the world’s largest and most comprehensive gathering of gastroenterology clinicians, researchers and industry. Registration and housing are now open, and AGA members can save up to $380 on registration fees. Discounted registration rates are also available through the March 13 early bird deadline. AGA member trainees, students, residents and postdoctoral fellows can register for free through this date. Visit ddw.org/register to join us.

This year, DDW takes place May 18-21, in Washington, D.C., and online. Whether you work in patient care, research, training or academia, you’ll find content tailored to your essential role at every step.

Add on to your DDW experience with AGA’s one-day Postgraduate Course. Join us on May 18, from D.C. or online, to explore challenging patient cases, high-impact papers, and important practice updates that you can use immediately upon your return to the clinic. Learn more at pgcourse.gastro.org.

Follow your own path to better outcomes for patients with GI diseases at Digestive Disease Week^® (DDW) 2024, the world’s largest and most comprehensive gathering of gastroenterology clinicians, researchers and industry. Registration and housing are now open, and AGA members can save up to $380 on registration fees. Discounted registration rates are also available through the March 13 early bird deadline. AGA member trainees, students, residents and postdoctoral fellows can register for free through this date. Visit ddw.org/register to join us.

This year, DDW takes place May 18-21, in Washington, D.C., and online. Whether you work in patient care, research, training or academia, you’ll find content tailored to your essential role at every step.

Add on to your DDW experience with AGA’s one-day Postgraduate Course. Join us on May 18, from D.C. or online, to explore challenging patient cases, high-impact papers, and important practice updates that you can use immediately upon your return to the clinic. Learn more at pgcourse.gastro.org.

In 2023, CHEST awarded $300,000 in clinical research and community impact grants to 15 individuals. Grant recipients are recognized for their scientifically meritorious achievements, with rigorous metrics to track their project’s progress, and have innovative, novel approaches to addressing their research topic.

CHEST grants have made a difference in patients’ lives by leading to breakthroughs in the treatment and/or management of chest diseases and patient care. This year’s grant-funded projects run the gamut of topics within chest medicine, ranging from lung cancer and COPD to tuberculosis and idiopathic pulmonary fibrosis.

Here’s a glimpse into two of this year’s grant winners and their projects.

For a full list of the 2023 grant winners, visit chestnet.org/grant-recipients.
 

Air pollution in sarcoidosis

This year, the John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis was awarded to Ali Mustafa, MD, of the Johns Hopkins Hospital in Baltimore, MD, for his project “Air Pollution in Sarcoidosis.”

Courtesy CHEST

The project’s aim is to investigate the feasibility of studying indoor and outdoor air pollution in patients with pulmonary sarcoidosis.

According to Dr. Mustafa’s application, pulmonary sarcoidosis is one of the most common interstitial lung diseases in the United States, and mortality due to sarcoidosis has risen by more than 3% in recent decades.

While the etiology of sarcoidosis remains elusive, evidence points toward a combination of genetic predisposition with external environmental triggers affecting disease onset. One small study of 16 individuals with fibrotic pulmonary sarcoidosis assessed the association between local levels of outdoor air pollutants to clinical outcomes. This study found that increased short-term exposure was associated with increased respiratory symptom severity and worse health-related quality of life.

Additionally, significant health disparities exist in sarcoidosis. Black individuals with sarcoidosis have worse pulmonary function, higher rates of multiorgan disease, and as much as a 12-fold increase in mortality compared with non-Hispanic White individuals with sarcoidosis. Socioeconomic status and Black race have also been associated with increased exposure to air pollution and closer proximity to high toxic emission facilities, suggesting higher exposure to outdoor air pollution.

Racial disparities are present and particularly important in sarcoidosis. Black individuals are more likely to have more advanced disease at diagnosis, have a six-fold increase in hospitalization, and a 12-fold increase in mortality compared with non-Hispanic White individuals with sarcoidosis. Little is known about the drivers of these disparities; however, environmental exposure has been implicated in sarcoidosis pathogenesis and incidence and may be an important contributor.

Dr. Mustafa’s preliminary work suggests disparities in exposure to air pollution among individuals with sarcoidosis may be contributing to inequities in clinical outcomes.
 

Determinants of medication non-adherence among adults with chronic obstructive pulmonary disease

The CHEST/ALA/ATS Respiratory Health Equity Research Award was given to Stephanie LaBedz, MD, of the University of Illinois Chicago. The Respiratory Health Equity Research Award is jointly supported by the American Lung Association, the American Thoracic Society, and CHEST.

Courtesy CHEST

Dr. LaBedz’s project, “Determinants of Medication Non-Adherence Among Adults With Chronic Obstructive Pulmonary Disease,” aims to use behavioral science theory to identify barriers and facilitators to COPD medication adherence.

Studies suggest racial minorities and individuals of low socioeconomic status (SES) are less likely to be adherent to COPD medications compared with White and high SES patients with COPD. Interventions designed to improve COPD medication adherence must address barriers to adherence experienced by these groups to avoid perpetuating disparities in adherence and downstream outcomes disparities.

For her project, Dr. LaBedz will focus on examining barriers and facilitators of COPD medication adherence, including social determinants of health and other structural barriers faced by these vulnerable populations. She will use the information gained from the qualitative study to design interventions that address the barriers to adherence faced by these groups.

Her long-term goal is to improve COPD medication adherence in vulnerable patients with COPD in order to improve the health status and reduce health disparities experienced by racial/ethnic minority and low SES patients with COPD.

In 2023, CHEST awarded $300,000 in clinical research and community impact grants to 15 individuals. Grant recipients are recognized for their scientifically meritorious achievements, with rigorous metrics to track their project’s progress, and have innovative, novel approaches to addressing their research topic.

CHEST grants have made a difference in patients’ lives by leading to breakthroughs in the treatment and/or management of chest diseases and patient care. This year’s grant-funded projects run the gamut of topics within chest medicine, ranging from lung cancer and COPD to tuberculosis and idiopathic pulmonary fibrosis.

Here’s a glimpse into two of this year’s grant winners and their projects.

For a full list of the 2023 grant winners, visit chestnet.org/grant-recipients.
 

Air pollution in sarcoidosis

This year, the John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis was awarded to Ali Mustafa, MD, of the Johns Hopkins Hospital in Baltimore, MD, for his project “Air Pollution in Sarcoidosis.”

Courtesy CHEST

The project’s aim is to investigate the feasibility of studying indoor and outdoor air pollution in patients with pulmonary sarcoidosis.

According to Dr. Mustafa’s application, pulmonary sarcoidosis is one of the most common interstitial lung diseases in the United States, and mortality due to sarcoidosis has risen by more than 3% in recent decades.

While the etiology of sarcoidosis remains elusive, evidence points toward a combination of genetic predisposition with external environmental triggers affecting disease onset. One small study of 16 individuals with fibrotic pulmonary sarcoidosis assessed the association between local levels of outdoor air pollutants to clinical outcomes. This study found that increased short-term exposure was associated with increased respiratory symptom severity and worse health-related quality of life.

Additionally, significant health disparities exist in sarcoidosis. Black individuals with sarcoidosis have worse pulmonary function, higher rates of multiorgan disease, and as much as a 12-fold increase in mortality compared with non-Hispanic White individuals with sarcoidosis. Socioeconomic status and Black race have also been associated with increased exposure to air pollution and closer proximity to high toxic emission facilities, suggesting higher exposure to outdoor air pollution.

Racial disparities are present and particularly important in sarcoidosis. Black individuals are more likely to have more advanced disease at diagnosis, have a six-fold increase in hospitalization, and a 12-fold increase in mortality compared with non-Hispanic White individuals with sarcoidosis. Little is known about the drivers of these disparities; however, environmental exposure has been implicated in sarcoidosis pathogenesis and incidence and may be an important contributor.

Dr. Mustafa’s preliminary work suggests disparities in exposure to air pollution among individuals with sarcoidosis may be contributing to inequities in clinical outcomes.
 

Determinants of medication non-adherence among adults with chronic obstructive pulmonary disease

The CHEST/ALA/ATS Respiratory Health Equity Research Award was given to Stephanie LaBedz, MD, of the University of Illinois Chicago. The Respiratory Health Equity Research Award is jointly supported by the American Lung Association, the American Thoracic Society, and CHEST.

Courtesy CHEST

Dr. LaBedz’s project, “Determinants of Medication Non-Adherence Among Adults With Chronic Obstructive Pulmonary Disease,” aims to use behavioral science theory to identify barriers and facilitators to COPD medication adherence.

Studies suggest racial minorities and individuals of low socioeconomic status (SES) are less likely to be adherent to COPD medications compared with White and high SES patients with COPD. Interventions designed to improve COPD medication adherence must address barriers to adherence experienced by these groups to avoid perpetuating disparities in adherence and downstream outcomes disparities.

For her project, Dr. LaBedz will focus on examining barriers and facilitators of COPD medication adherence, including social determinants of health and other structural barriers faced by these vulnerable populations. She will use the information gained from the qualitative study to design interventions that address the barriers to adherence faced by these groups.

Her long-term goal is to improve COPD medication adherence in vulnerable patients with COPD in order to improve the health status and reduce health disparities experienced by racial/ethnic minority and low SES patients with COPD.

In 2023, CHEST awarded $300,000 in clinical research and community impact grants to 15 individuals. Grant recipients are recognized for their scientifically meritorious achievements, with rigorous metrics to track their project’s progress, and have innovative, novel approaches to addressing their research topic.

CHEST grants have made a difference in patients’ lives by leading to breakthroughs in the treatment and/or management of chest diseases and patient care. This year’s grant-funded projects run the gamut of topics within chest medicine, ranging from lung cancer and COPD to tuberculosis and idiopathic pulmonary fibrosis.

Here’s a glimpse into two of this year’s grant winners and their projects.

For a full list of the 2023 grant winners, visit chestnet.org/grant-recipients.
 

Air pollution in sarcoidosis

This year, the John R. Addrizzo, MD, FCCP Research Grant in Sarcoidosis was awarded to Ali Mustafa, MD, of the Johns Hopkins Hospital in Baltimore, MD, for his project “Air Pollution in Sarcoidosis.”

Courtesy CHEST

The project’s aim is to investigate the feasibility of studying indoor and outdoor air pollution in patients with pulmonary sarcoidosis.

According to Dr. Mustafa’s application, pulmonary sarcoidosis is one of the most common interstitial lung diseases in the United States, and mortality due to sarcoidosis has risen by more than 3% in recent decades.

While the etiology of sarcoidosis remains elusive, evidence points toward a combination of genetic predisposition with external environmental triggers affecting disease onset. One small study of 16 individuals with fibrotic pulmonary sarcoidosis assessed the association between local levels of outdoor air pollutants to clinical outcomes. This study found that increased short-term exposure was associated with increased respiratory symptom severity and worse health-related quality of life.

Additionally, significant health disparities exist in sarcoidosis. Black individuals with sarcoidosis have worse pulmonary function, higher rates of multiorgan disease, and as much as a 12-fold increase in mortality compared with non-Hispanic White individuals with sarcoidosis. Socioeconomic status and Black race have also been associated with increased exposure to air pollution and closer proximity to high toxic emission facilities, suggesting higher exposure to outdoor air pollution.

Racial disparities are present and particularly important in sarcoidosis. Black individuals are more likely to have more advanced disease at diagnosis, have a six-fold increase in hospitalization, and a 12-fold increase in mortality compared with non-Hispanic White individuals with sarcoidosis. Little is known about the drivers of these disparities; however, environmental exposure has been implicated in sarcoidosis pathogenesis and incidence and may be an important contributor.

Dr. Mustafa’s preliminary work suggests disparities in exposure to air pollution among individuals with sarcoidosis may be contributing to inequities in clinical outcomes.
 

Determinants of medication non-adherence among adults with chronic obstructive pulmonary disease

The CHEST/ALA/ATS Respiratory Health Equity Research Award was given to Stephanie LaBedz, MD, of the University of Illinois Chicago. The Respiratory Health Equity Research Award is jointly supported by the American Lung Association, the American Thoracic Society, and CHEST.

Courtesy CHEST

Dr. LaBedz’s project, “Determinants of Medication Non-Adherence Among Adults With Chronic Obstructive Pulmonary Disease,” aims to use behavioral science theory to identify barriers and facilitators to COPD medication adherence.

Studies suggest racial minorities and individuals of low socioeconomic status (SES) are less likely to be adherent to COPD medications compared with White and high SES patients with COPD. Interventions designed to improve COPD medication adherence must address barriers to adherence experienced by these groups to avoid perpetuating disparities in adherence and downstream outcomes disparities.

For her project, Dr. LaBedz will focus on examining barriers and facilitators of COPD medication adherence, including social determinants of health and other structural barriers faced by these vulnerable populations. She will use the information gained from the qualitative study to design interventions that address the barriers to adherence faced by these groups.

Her long-term goal is to improve COPD medication adherence in vulnerable patients with COPD in order to improve the health status and reduce health disparities experienced by racial/ethnic minority and low SES patients with COPD.

The practice of initiating early and adequate nutrition in critically ill patients is a cornerstone of ICU management. Adequate nutrition combats the dangerous catabolic state that accompanies critical illness. A few of the benefits of this practice are a decrease in disease severity with resultant lessened hospital and ICU lengths of stay, reduced infection rates, and a decrease in hospital mortality. Enteral nutrition (EN) is the route of nutritional support most associated with safe and effective provision of enhanced immunologic function and the ability to preserve the patient’s lean body mass while avoiding metabolic and infectious complications.

The practice of initiating early and adequate nutrition in critically ill patients is a cornerstone of ICU management. Adequate nutrition combats the dangerous catabolic state that accompanies critical illness. A few of the benefits of this practice are a decrease in disease severity with resultant lessened hospital and ICU lengths of stay, reduced infection rates, and a decrease in hospital mortality. Enteral nutrition (EN) is the route of nutritional support most associated with safe and effective provision of enhanced immunologic function and the ability to preserve the patient’s lean body mass while avoiding metabolic and infectious complications.

The practice of initiating early and adequate nutrition in critically ill patients is a cornerstone of ICU management. Adequate nutrition combats the dangerous catabolic state that accompanies critical illness. A few of the benefits of this practice are a decrease in disease severity with resultant lessened hospital and ICU lengths of stay, reduced infection rates, and a decrease in hospital mortality. Enteral nutrition (EN) is the route of nutritional support most associated with safe and effective provision of enhanced immunologic function and the ability to preserve the patient’s lean body mass while avoiding metabolic and infectious complications.

Pulmonary physicians and particularly interventional bronchoscopists have been receiving denials when CPT^® codes 31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe and 31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) are billed during the same procedure.

While the difference between a transbronchial forceps biopsy and transbronchial needle biopsy are obvious to bronchoscopists, there has been confusion with payers. This could have been partly on the basis of a CPT Assistant article from March 2021 describing the use of both codes that stated, “Note that performing two types of lung biopsy (forceps and needle aspiration) on the same lesion would be considered unusual and documentation of medical necessity should clearly describe why both types of biopsy were clinically necessary.” This may have been interpreted by coders and/or payers to mean that the two codes should be billed together rarely or not at all. It is also possible that computer-based coding programs (eg, Optum/Encoder Pro, etc) are responsible for these inappropriate denials. There are, however, no NCCI edits that disallow this nor was this the intent of the CPT codes when they were developed.

The previous statement from the CPT Assistant article was clarified in the following sentences, “For example, if needle aspiration were performed and immediate screening of the sample were insufficient for diagnosis, a forceps biopsy would be appropriate and reported separately. On the other hand, if a physician performed a needle aspiration out of concern that the lesion was vascular and found that it was not and proceeded with a forceps biopsy, then the needle aspiration would be integral to the forceps biopsy and not separately reported.” Importantly, with the increasing use of navigational bronchoscopy and robotic bronchoscopy, these codes will be used together more frequently, appropriately, and correctly, especially on distal lesions.

Remember, these codes are used for procedures in a single lobe. If multiple lobes are sampled then CPT codes 31632 and 31633 would be added to 31628 and 31629, respectively. If one is receiving denials for these procedures, coders and payers should be notified of these errors, and denials should be appealed.

Q&A

Question: My practice is wondering if we can use the newer codes for online digital E/M services? We know they are time-based, but we are confused about when they cannot be used. Can you please help? For example, I had an established COPD patient send a message through the electronic health record’s patient portal reporting new symptoms of headache, cough, and sputum production. They asked me to review the chest x-ray that was done two days prior when they went to urgent care. The patient is asking for an assessment and management plan. We message back and forth over the next day for a total of 13 minutes. Three days later, the patient developed more symptoms and then scheduled an office visit. How would I bill for this? 99212-99215 (Established Office E/M) or 99422 (Online digital E/M 11-20 minutes?

Answer: Online Digital E/M services (99421, 99422, 99423) are to be used for established patients, only. They are time-based codes and cumulative up to seven days. They are to be reported for asynchronous communication via HIPAA-compliance secure platforms, such as through the electronic health record portal, portal email, etc. They may not be reported if an E/M occurs within seven days before or after, though the time may be incorporated into the subsequent E/M. These codes are not to be used for communication of test results, scheduling of appointments, or other communication that does not include E/M. In your example, you would report the appropriate Office/ Outpatient Established CPT code (99212-99215).


99421 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

99422 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes

99423 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes


Question: Is Cardiopulmonary Resuscitation in the Intensive Care Unit considered to be part of Critical Care services? (99291- 99292)? There appears to be confusion in our billing department on this issue.

Answer: 92959 Cardiopulmonary resuscitation is not bundled into 99291-99292. Consider it as a procedure. To code for this service in addition to Critical Care, the time for the CPR must be separate from the time for Critical Care (99291-99292). A separate procedure note must also be documented. There is no minimum time for this service, and a 25 modifier must be included, as well. 92950 reimburses at 4.00 wRVUs and may be reported two times per calendar day.

Originally published in the September 2023 issue of the American Thoracic Society’s ATS Coding & Billing Quarterly. Republished with permission from the American Thoracic Society.

Pulmonary physicians and particularly interventional bronchoscopists have been receiving denials when CPT^® codes 31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe and 31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) are billed during the same procedure.

While the difference between a transbronchial forceps biopsy and transbronchial needle biopsy are obvious to bronchoscopists, there has been confusion with payers. This could have been partly on the basis of a CPT Assistant article from March 2021 describing the use of both codes that stated, “Note that performing two types of lung biopsy (forceps and needle aspiration) on the same lesion would be considered unusual and documentation of medical necessity should clearly describe why both types of biopsy were clinically necessary.” This may have been interpreted by coders and/or payers to mean that the two codes should be billed together rarely or not at all. It is also possible that computer-based coding programs (eg, Optum/Encoder Pro, etc) are responsible for these inappropriate denials. There are, however, no NCCI edits that disallow this nor was this the intent of the CPT codes when they were developed.

The previous statement from the CPT Assistant article was clarified in the following sentences, “For example, if needle aspiration were performed and immediate screening of the sample were insufficient for diagnosis, a forceps biopsy would be appropriate and reported separately. On the other hand, if a physician performed a needle aspiration out of concern that the lesion was vascular and found that it was not and proceeded with a forceps biopsy, then the needle aspiration would be integral to the forceps biopsy and not separately reported.” Importantly, with the increasing use of navigational bronchoscopy and robotic bronchoscopy, these codes will be used together more frequently, appropriately, and correctly, especially on distal lesions.

Remember, these codes are used for procedures in a single lobe. If multiple lobes are sampled then CPT codes 31632 and 31633 would be added to 31628 and 31629, respectively. If one is receiving denials for these procedures, coders and payers should be notified of these errors, and denials should be appealed.

Q&A

Question: My practice is wondering if we can use the newer codes for online digital E/M services? We know they are time-based, but we are confused about when they cannot be used. Can you please help? For example, I had an established COPD patient send a message through the electronic health record’s patient portal reporting new symptoms of headache, cough, and sputum production. They asked me to review the chest x-ray that was done two days prior when they went to urgent care. The patient is asking for an assessment and management plan. We message back and forth over the next day for a total of 13 minutes. Three days later, the patient developed more symptoms and then scheduled an office visit. How would I bill for this? 99212-99215 (Established Office E/M) or 99422 (Online digital E/M 11-20 minutes?

Answer: Online Digital E/M services (99421, 99422, 99423) are to be used for established patients, only. They are time-based codes and cumulative up to seven days. They are to be reported for asynchronous communication via HIPAA-compliance secure platforms, such as through the electronic health record portal, portal email, etc. They may not be reported if an E/M occurs within seven days before or after, though the time may be incorporated into the subsequent E/M. These codes are not to be used for communication of test results, scheduling of appointments, or other communication that does not include E/M. In your example, you would report the appropriate Office/ Outpatient Established CPT code (99212-99215).


99421 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

99422 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes

99423 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes


Question: Is Cardiopulmonary Resuscitation in the Intensive Care Unit considered to be part of Critical Care services? (99291- 99292)? There appears to be confusion in our billing department on this issue.

Answer: 92959 Cardiopulmonary resuscitation is not bundled into 99291-99292. Consider it as a procedure. To code for this service in addition to Critical Care, the time for the CPR must be separate from the time for Critical Care (99291-99292). A separate procedure note must also be documented. There is no minimum time for this service, and a 25 modifier must be included, as well. 92950 reimburses at 4.00 wRVUs and may be reported two times per calendar day.

Originally published in the September 2023 issue of the American Thoracic Society’s ATS Coding & Billing Quarterly. Republished with permission from the American Thoracic Society.

Pulmonary physicians and particularly interventional bronchoscopists have been receiving denials when CPT^® codes 31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe and 31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) are billed during the same procedure.

While the difference between a transbronchial forceps biopsy and transbronchial needle biopsy are obvious to bronchoscopists, there has been confusion with payers. This could have been partly on the basis of a CPT Assistant article from March 2021 describing the use of both codes that stated, “Note that performing two types of lung biopsy (forceps and needle aspiration) on the same lesion would be considered unusual and documentation of medical necessity should clearly describe why both types of biopsy were clinically necessary.” This may have been interpreted by coders and/or payers to mean that the two codes should be billed together rarely or not at all. It is also possible that computer-based coding programs (eg, Optum/Encoder Pro, etc) are responsible for these inappropriate denials. There are, however, no NCCI edits that disallow this nor was this the intent of the CPT codes when they were developed.

The previous statement from the CPT Assistant article was clarified in the following sentences, “For example, if needle aspiration were performed and immediate screening of the sample were insufficient for diagnosis, a forceps biopsy would be appropriate and reported separately. On the other hand, if a physician performed a needle aspiration out of concern that the lesion was vascular and found that it was not and proceeded with a forceps biopsy, then the needle aspiration would be integral to the forceps biopsy and not separately reported.” Importantly, with the increasing use of navigational bronchoscopy and robotic bronchoscopy, these codes will be used together more frequently, appropriately, and correctly, especially on distal lesions.

Remember, these codes are used for procedures in a single lobe. If multiple lobes are sampled then CPT codes 31632 and 31633 would be added to 31628 and 31629, respectively. If one is receiving denials for these procedures, coders and payers should be notified of these errors, and denials should be appealed.

Q&A

Question: My practice is wondering if we can use the newer codes for online digital E/M services? We know they are time-based, but we are confused about when they cannot be used. Can you please help? For example, I had an established COPD patient send a message through the electronic health record’s patient portal reporting new symptoms of headache, cough, and sputum production. They asked me to review the chest x-ray that was done two days prior when they went to urgent care. The patient is asking for an assessment and management plan. We message back and forth over the next day for a total of 13 minutes. Three days later, the patient developed more symptoms and then scheduled an office visit. How would I bill for this? 99212-99215 (Established Office E/M) or 99422 (Online digital E/M 11-20 minutes?

Answer: Online Digital E/M services (99421, 99422, 99423) are to be used for established patients, only. They are time-based codes and cumulative up to seven days. They are to be reported for asynchronous communication via HIPAA-compliance secure platforms, such as through the electronic health record portal, portal email, etc. They may not be reported if an E/M occurs within seven days before or after, though the time may be incorporated into the subsequent E/M. These codes are not to be used for communication of test results, scheduling of appointments, or other communication that does not include E/M. In your example, you would report the appropriate Office/ Outpatient Established CPT code (99212-99215).


99421 – Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes

99422 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes

99423 - Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes


Question: Is Cardiopulmonary Resuscitation in the Intensive Care Unit considered to be part of Critical Care services? (99291- 99292)? There appears to be confusion in our billing department on this issue.

Answer: 92959 Cardiopulmonary resuscitation is not bundled into 99291-99292. Consider it as a procedure. To code for this service in addition to Critical Care, the time for the CPR must be separate from the time for Critical Care (99291-99292). A separate procedure note must also be documented. There is no minimum time for this service, and a 25 modifier must be included, as well. 92950 reimburses at 4.00 wRVUs and may be reported two times per calendar day.

Originally published in the September 2023 issue of the American Thoracic Society’s ATS Coding & Billing Quarterly. Republished with permission from the American Thoracic Society.

Looking ahead to 2024, one notable accomplishment of the past 12 months that will guide our organization for years to come was to establish CHEST organizational values. The result of a collaborative process that was led by the Value-Setting Work Group and informed by CHEST leaders, members, and staff, the CHEST values are Community, Inclusivity, Innovation, Advocacy, and Integrity.

The process to arrive at these values was intentionally designed to ensure input from all corners of the organization. Over the course of 5 months, CHEST members had the opportunity to participate in focus groups or submit written feedback about the proposed values. The feedback shaped subsequent iterations of the values that the work group produced, finally arriving at these five.

“These values are meant to be reflective of the CHEST organization and all of its leaders, members, and staff,” said Co-Chair of the Value-Setting Work Group and CHEST Board of Regents Member Nneka Sederstrom, PhD, FCCP. “As a society, we’ve come to a point where we can’t pretend that real life issues don’t matter to our patients and to our members. It’s become a pivotal point in our world for our systems to be clear on who they are. All too often, the question of, ‘Is this our lane?’ comes up. These values are a succinct way to show not only what falls into our ‘lane,’ but that we celebrate where we stand. It was a big undertaking, but seeing the collaboration and passion was exceptional.”

The work group was co-chaired by Dr. Sederstrom and Elizabeth Stigler, PhD, and was supported by David Zielinski, MD, FCCP; Bravein Amalakuhan, MD; Alisha Young, MD; Steven Simpson, MD, FCCP; Nehan Sher, MD; and CHEST staff members, Teresa Rodriguez, Manager, CHEST Annual Meeting; Terri Horton-O’Connell, MSW, Director, Grant and Proposal Development; and Vanessa Rancine, Recruiting Specialist.

Beyond solidifying the five succinct values, the work group strategically defined each value to clarify its intent.
 

• Community: We invest in the support, growth, and development of everyone involved with CHEST, both individually and collectively, and are tireless champions for one another.
• Inclusivity: We cherish the diverse perspectives and experiences of our community members and amplify their unique voices.
• Innovation: We strive for excellence in all that we do with an adaptable and ever-evolving perspective. We pursue bold, future-oriented possibilities for constant improvement and continual growth.
• Advocacy: We courageously and intentionally create and foster positive changes for our patients and their families, our members and staff, and the next generation of CHEST clinicians.
• Integrity: We take pride in acting responsibly with respect, honesty, and accountability that engenders trust.

“With the new values in place, hopefully, our members will feel a shift in how we, as an organization, show up when anything occurs,” Dr. Sederstrom said. “The values will be reflected through community engagement and support and will be deeply integrated into the CHEST Annual Meeting. When someone asks CHEST, ‘Who are you?’ -we can now answer it with certitude.”

Looking ahead to 2024, one notable accomplishment of the past 12 months that will guide our organization for years to come was to establish CHEST organizational values. The result of a collaborative process that was led by the Value-Setting Work Group and informed by CHEST leaders, members, and staff, the CHEST values are Community, Inclusivity, Innovation, Advocacy, and Integrity.

The process to arrive at these values was intentionally designed to ensure input from all corners of the organization. Over the course of 5 months, CHEST members had the opportunity to participate in focus groups or submit written feedback about the proposed values. The feedback shaped subsequent iterations of the values that the work group produced, finally arriving at these five.

“These values are meant to be reflective of the CHEST organization and all of its leaders, members, and staff,” said Co-Chair of the Value-Setting Work Group and CHEST Board of Regents Member Nneka Sederstrom, PhD, FCCP. “As a society, we’ve come to a point where we can’t pretend that real life issues don’t matter to our patients and to our members. It’s become a pivotal point in our world for our systems to be clear on who they are. All too often, the question of, ‘Is this our lane?’ comes up. These values are a succinct way to show not only what falls into our ‘lane,’ but that we celebrate where we stand. It was a big undertaking, but seeing the collaboration and passion was exceptional.”

The work group was co-chaired by Dr. Sederstrom and Elizabeth Stigler, PhD, and was supported by David Zielinski, MD, FCCP; Bravein Amalakuhan, MD; Alisha Young, MD; Steven Simpson, MD, FCCP; Nehan Sher, MD; and CHEST staff members, Teresa Rodriguez, Manager, CHEST Annual Meeting; Terri Horton-O’Connell, MSW, Director, Grant and Proposal Development; and Vanessa Rancine, Recruiting Specialist.

Beyond solidifying the five succinct values, the work group strategically defined each value to clarify its intent.
 

• Community: We invest in the support, growth, and development of everyone involved with CHEST, both individually and collectively, and are tireless champions for one another.
• Inclusivity: We cherish the diverse perspectives and experiences of our community members and amplify their unique voices.
• Innovation: We strive for excellence in all that we do with an adaptable and ever-evolving perspective. We pursue bold, future-oriented possibilities for constant improvement and continual growth.
• Advocacy: We courageously and intentionally create and foster positive changes for our patients and their families, our members and staff, and the next generation of CHEST clinicians.
• Integrity: We take pride in acting responsibly with respect, honesty, and accountability that engenders trust.

“With the new values in place, hopefully, our members will feel a shift in how we, as an organization, show up when anything occurs,” Dr. Sederstrom said. “The values will be reflected through community engagement and support and will be deeply integrated into the CHEST Annual Meeting. When someone asks CHEST, ‘Who are you?’ -we can now answer it with certitude.”

Looking ahead to 2024, one notable accomplishment of the past 12 months that will guide our organization for years to come was to establish CHEST organizational values. The result of a collaborative process that was led by the Value-Setting Work Group and informed by CHEST leaders, members, and staff, the CHEST values are Community, Inclusivity, Innovation, Advocacy, and Integrity.

The process to arrive at these values was intentionally designed to ensure input from all corners of the organization. Over the course of 5 months, CHEST members had the opportunity to participate in focus groups or submit written feedback about the proposed values. The feedback shaped subsequent iterations of the values that the work group produced, finally arriving at these five.

“These values are meant to be reflective of the CHEST organization and all of its leaders, members, and staff,” said Co-Chair of the Value-Setting Work Group and CHEST Board of Regents Member Nneka Sederstrom, PhD, FCCP. “As a society, we’ve come to a point where we can’t pretend that real life issues don’t matter to our patients and to our members. It’s become a pivotal point in our world for our systems to be clear on who they are. All too often, the question of, ‘Is this our lane?’ comes up. These values are a succinct way to show not only what falls into our ‘lane,’ but that we celebrate where we stand. It was a big undertaking, but seeing the collaboration and passion was exceptional.”

The work group was co-chaired by Dr. Sederstrom and Elizabeth Stigler, PhD, and was supported by David Zielinski, MD, FCCP; Bravein Amalakuhan, MD; Alisha Young, MD; Steven Simpson, MD, FCCP; Nehan Sher, MD; and CHEST staff members, Teresa Rodriguez, Manager, CHEST Annual Meeting; Terri Horton-O’Connell, MSW, Director, Grant and Proposal Development; and Vanessa Rancine, Recruiting Specialist.

Beyond solidifying the five succinct values, the work group strategically defined each value to clarify its intent.
 

• Community: We invest in the support, growth, and development of everyone involved with CHEST, both individually and collectively, and are tireless champions for one another.
• Inclusivity: We cherish the diverse perspectives and experiences of our community members and amplify their unique voices.
• Innovation: We strive for excellence in all that we do with an adaptable and ever-evolving perspective. We pursue bold, future-oriented possibilities for constant improvement and continual growth.
• Advocacy: We courageously and intentionally create and foster positive changes for our patients and their families, our members and staff, and the next generation of CHEST clinicians.
• Integrity: We take pride in acting responsibly with respect, honesty, and accountability that engenders trust.

“With the new values in place, hopefully, our members will feel a shift in how we, as an organization, show up when anything occurs,” Dr. Sederstrom said. “The values will be reflected through community engagement and support and will be deeply integrated into the CHEST Annual Meeting. When someone asks CHEST, ‘Who are you?’ -we can now answer it with certitude.”