SGO Issues Jan 10, 2019

SGO celebrates golden anniversary in 2019
Journal article explores disparities in allocation of research funding
Changes to Sentinel Lymph Node coding for 2019 | Chirag A. Shah, MD
Coding for SLN procedures: 2019 changes for staff use | David O. Holtz, MD
Funding opportunities available for ovarian cancer research through DoD
GOG Foundation announces two investigator award RFAs
New email/mailing list order forms on SGO website
SGO Open Election begins Jan. 14

SGO celebrates golden anniversary in 2019

This year, the Society of Gynecologic Oncology marks 50 years as the premier medical society for our subspecialty. A number of special events and presentations have been planned for the 2019 SGO Annual Meeting on Women’s Cancer to acknowledge significant milestones in SGO’s history. Throughout 2019, SGO will honor leaders in gynecologic oncology who have pushed the boundaries of women’s cancer care practice. This week, SGO President Carol L. Brown, MD, addresses the Society’s legacy of growth and inclusion. Additional interview content from SGO members will be added to the SGO50.org website and shared through social media throughout the year. We encourage all members to share their favorite SGO memories by posting pictures and stories of special events, career mentors, and Annual Meeting experiences on Facebook, LinkedIn, and Twitter using the hashtag #SGO50 and tagging @SGO_org. We look forward to celebrating with you!

Journal article explores disparities in allocation of research funding

The January 2019 edition of Gynecologic Oncology has published, “Disparities in the allocation of research funding to gynecologic cancers by Funding to Lethality scores,” which was initially presented during the opening scientific plenary at the 2018 SGO Annual Meeting on Women’s Cancer in New Orleans. Funding to Lethality scores were calculated for 18 different cancers by using the total amount of annual funding in U.S. dollars reported by the National Cancer Institute divided by the person-years of life lost per 100 new cases of each cancer. This metric suggested that gynecologic malignancies received significantly lower funding than many other cancer sites, adding that “prompt correction is required to ensure critical discoveries for women with gynecologic cancers.”

Authors Ryan Spencer, MD; Laurel Rice, MD, Clara Ye, MD; Kaitlin Woo, MS; and Shitanshu Uppal, MD, found that ovarian, cervical, and uterine cancers ranked 10th, 12th, and 14th, respectively, for average Funding to Lethality scores over the 8-year period for which all data was available for analysis (2007-2014). Although trending lower over the 8-year period, prostate cancer still had the highest average score. This correlated to an average funding allocation of $1,821,000 per person-years of life lost from each 100 new diagnoses. For comparison, ovarian cancer received $97,000, cervical cancer $87,000, and uterine cancer $57,000. Ovarian and cervical cancers had significantly lower average Funding to Lethality scores compared to nine other cancers, while uterine cancer was lower than 13 others.

“Based on the fact that gynecologic cancers have a significantly lower number of NCCN category I guidelines than many others, including those of similar incidence and mortality, we wanted to explore if there were funding disparities in cancer research,” said lead author Dr. Spencer. “While there are numerous sources of funding for cancer research and clinical trials, the NCI is the largest and most important.”

Dr. Spencer added that while there are other studies that have looked at funding allocation for cancer research, the authors wanted to use a metric that standardized cancer mortality and incidence and incorporated the average number of person-years of life lost due to each cancer diagnosed.

“The SGO Legislative and Regulatory Affairs Task Force has been a great partner in supporting the dissemination of this data and numerous members from the Foundation for Women’s Cancer have offered great interest and support as well,” he said. The data was presented to participants at the SGO Fly-in day on Capitol Hill in September 2018 so that it could be used in discussions regarding increasing funding for gynecologic cancers in discussions with members of Congress.

Moving forward, Dr. Spencer said that the best way to utilize these findings would be to explore a way to correlate funding to the impact on cancer survival – although he noted that because so many factors exist in between funding allocation and altering survival through clinical trials, this would be a challenging task.

“For the time being, our plan is to continue to track funding for gynecologic cancers over time and to monitor how that correlates to the creation of high quality evidence to best treat our patients,” he said. “We need to continue to explore potential funding disparities and engage policy-makers on an increasing scale.”

Changes to Sentinel Lymph Node coding for 2019 | Chirag A. Shah, MD

Chirag A. Shah, MD

An area of emerging technique and increasing utilization in gynecologic oncology is sentinel lymph node (SLN) mapping. At last year’s SGO Annual Meeting on Women’s Cancer there were 19 different papers presented on various aspects of SLN mapping in gynecologic cancers.  However, one place where there has been considerable uncertainty is how to bill for these procedures. As of Jan. 1, 2019, there is more clarity with changes to the CPT codes.

Due to the efforts of the SGO Coding Taskforce and the American College of Obstetricians and Gynecologists (ACOG) Committee on Health Economics and Coding, there are updates to the existing code +38900 (Intraoperative identification (e.g., mapping) of sentinel lymph nodes) and a new code for vulvar SLN mapping 38531 (Biopsy or excision of lymph nodes, inguinofemoral node), effective Jan. 1, 2019.  The use of these codes is more specifically outlined below, but these changes are consistent with updated National Comprehensive Cancer Network (NCCN) guidelines for endometrial, cervical, and vulvar cancers.

CPT codes now provide a way for SGO members to bill for the procedures they perform regarding lymph node mapping.

+38900 Intraoperative identification (eg, mapping) of sentinel lymph nodes

• Can be billed with: 19302, 19307, 38500, 38510, 38520, 38525, 38530, 38531, 38542, 38562, 38564, 38570, 38571, 38572, 38740, 38745, 38760, 38765, 38770, 38780, 56630, 56631, 56632, 56633, 56634, 56637, 56640
• wRVU 2.50 (can be billed bilaterally)
• For example in an endometrial cancer case, correct billing of 38570 Laparoscopy, surgical; with retroperitoneal lymph node sampling (8.49 wRVU) + 38900 (2.50 wRVU x 2) = 13.49 wRVU

38531 Biopsy or excision of lymph nodes, inguinofemoral node

• Can be billed with +38900 add on code
• Can be billed unilateral or bilateral
• Can be billed at the time of a radical vulvectomy or as a subsequent separate procedure.
• Cannot be billed with more extensive lymphadenectomy codes or any vulvectomy codes that already incorporate lymph node dissection (i.e., 38760, 38765, or 56631-56640).

Chirag A. Shah, MD, is a gynecologic oncologist with Pacific Gynecology Specialists Seattle in Seattle, WA.

Coding for SLN procedures: 2019 changes for staff use | David O. Holtz, MD

David O. Holtz, MD

Starting Jan. 1, 2019, there will be changes to the parenthetical statement under CPT code +38900 regarding the CPT codes that it can be billed with for intraoperative identification (e.g., mapping) of sentinel lymph nodes (SLN) for gynecologic malignancies and a new CPT code for biopsy of inguinofemoral nodes. These 2019 coding changes will affect how you bill for lymph node dissections. These changes are based on the work of the SGO Coding Taskforce and the American College of Obstetricians and Gynecologists (ACOG) Committee on Health Economics and Coding.  

Previously, CPT code +38900 was restricted to procedures usually done for a diagnosis of breast cancer or melanoma and restricted from being billed with CPT codes for hysterectomies and vulvectomies. Given the acceptance of sentinel lymph node biopsy for vulvar cancer and endometrial cancer as seen in changes to the National Comprehensive Cancer Network (NCCN) guidelines over the past several years, this seemed like a good time to update the list of codes that CPT code +38900 could be billed with as supported by these NCCN guidelines.   

Prior to Jan. 1, 2019, gynecologic oncologists would have to use one of the open or laparoscopic lymph node sampling codes by themselves to bill for a sentinel lymph node dissection for endometrial or vulvar cancer.  These codes all pay approximately 3.0 work relative value units (wRVUs) less than lymphadenectomy procedures (see table below).  The ability to bill for the injection of dye makes up for the difference in work and allows for the facility to bill for the dye.

A new code has also been added that allows us to properly bill for the work performed during a groin dissection for sentinel lymph node biopsy. CPT 38531 (biopsy or excision of lymph node(s); open, inguinofemoral node(s)) was created as an intermediate code between a simple open biopsy of the lymph node (CPT 38500) and more complex total lymph node dissections. 

The new code CPT 38531 is intended to be used with the 38900 add on code, can be billed for just unilateral lymph nodes or used twice for bilateral lymph nodes. It can be billed at the time of a radical vulvectomy or as a subsequent separate procedure.  This code cannot be billed with more extensive lymphadenectomy codes or any of the radical vulvectomy codes that already incorporate lymph node dissection (i.e. 38760, 38765, or 56631-56640).

The permission from CMS to use the add on injection code for sentinel lymph node identification (+38900) along with the additional inguinofemoral lymph node dissection code (38531) will allow us to continue to be compensated for work as we transition toward sentinel lymph nodes in gynecologic malignancies.

David O. Holtz, MD, is a gynecologic oncologist with Lankenau Hospital in Wynnewood, PA.

Disclaimer: SGO members and professional coders may seek coding advice and recommendations by submitting an email to coding@sgo.org. Answers to incoming questions are provided by the members of the SGO Coding and Reimbursement Taskforce and represent their opinion based upon the current and usual practices in the field. Every effort is made to ensure the accuracy of the information provided. However, the information neither replaces information in Medicare regulations, the CPT-4 code book, or the ICD-9 CM code book; nor does it constitute legal advice. Responses to questions are intended only as a guide and are not a substitute for specific accounting or legal opinions. SGO expressly disclaims all responsibility and liability arising from use of, or reliance upon this information as a reference source, and assumes no responsibility or liability for any claims that may result directly or indirectly from use of this information, including, but not limited to, claims of Medicare or insurance fraud.

Funding opportunities available for ovarian cancer research through DoD

The Congressionally Directed Medical Research Programs (CDMRP) at the U.S. Army Medical Research and Materiel Command (USAMRMC) has released a pre-announcement of funding opportunities for Fiscal Year 2019 (FY19) for the Department of Defense (DoD) Ovarian Cancer Research Program (OCRP). This $20 million defense appropriation supports patient-centered research to prevent, detect, treat, and cure ovarian cancer to enhance the health and well-being of service members, veterans, retirees, their family members, and all women impacted by this disease. FY19 OCRP Program Announcements and General Application Instructions will be posted on the Grants.gov website later this month. Pre-application and application deadlines will be available when the Program Announcements are released. 

GOG Foundation announces two investigator award RFAs

The GOG Foundation, in collaboration with NRG Oncology and the Society for Gynecologic Oncology, is making a preliminary Request for Application (RFA) announcement for two investigator awards. The submissions will open on Feb. 18 and close March 29. Additional details and application forms will be available by Feb. 1 on GOG.org. The descriptions for these awards are as follows:

GOG Foundation Scholar Investigator Award: The purpose of this five-year award is to identify, enhance, and support training for Scholar Investigators who will be capable and committed to developing, executing, and leading gynecologic oncology clinical trials, conducting high-quality research related to gynecologic cancer, and participating in GOG Foundation/NRG Oncology and other relevant committee/leadership positions. 

GOG Foundation New Investigator Award: The purpose of this three-year award is to identify New Investigators with an interest in clinical trials in gynecologic cancers who wish to become more engaged with the GOG Foundation and NRG Oncology and to learn more about the gynecologic cancer clinical trial development process.  It is anticipated that New Investigators might pursue a GOG-Foundation Scholar Investigator Award at the time of future requests for applications of that award.

New email/mailing list order forms on SGO website

New order forms have been posted in the SGO store for mailing list rental and eSurvey lists. The new forms ensure the security of user data. Please use the new forms when requesting a mailing list, or email list for research surveys, and discard any old forms that may have been downloaded.

SGO Open Election begins Jan. 14

On Monday, Jan. 14, SGO members will receive an email from noreply@directvote.net for the SGO open election. The list of candidates for each position, including biographical information, personal statements and photos, will be available for your consideration on your ballot. Please take some time to review the candidates’ statements when casting your vote next week. This candidate information will also be available on the ballot. Voting ends at 11:59 p.m. CST on Tuesday, Feb. 12.