Getting reimbursed for gyn. surgery. (Tips from an Expert).

WASHINGTON -- To make a decent living as a gynecologic surgeon, you need to be productive every minute of every day and get reimbursed to the maximal degree for everything you do, Dr. Vincent R. Lucente said at a meeting on gynecologic surgery sponsored by the Washington Hospital Center.

It also helps to know the reimbursement system cold, said Dr. Lucente, a gynecologic surgeon at St. Luke's Hospital, Allentown, Pa. By doing all of his own CPT coding, Dr. Lucente. Estimates that his revenue from patient services is easily 20%-25% higher than that of his colleagues. But he also advises ob.gyns. not to be passive when it comes to dealing with third-party payers. Ob.gyns are notorious for undervaluing the work that they do, and insurance companies know that and take advantage of it, he observed.

When an insurance company sends a denial letter, "I'm the one engaged in negotiations about it. I don't write it off," he said Stand up for yourself enough and eventually the insurance companies "move on" and send their denial letters elsewhere.

If you don't go after every last dime that's legitimately yours, "you'll work like a mad man, and you're going to have a hard time paying your bills," said Dr. Lucente, who offered the following tips for maximizing your practice's income:

* Keep your codes up to date. Starting next year, there will be CPT codes for complex laparoscopically assisted vaginal hysterectomies involving uteri of at least 250 g and laparoscopic myomectomy procedures involving at least five myomas.

Entirely new CPT codes are also in the pipeline for laparoscopic procedures, including laparoscopic paravaginal defect repair, laparoscopic vaginal vault suspension, and laparoscopic excision of extensive deep-infiltrating endometriosis.

* Get involved. The goal is to create new and revised CPT codes that reward more labor-intensive laparoscopic procedures and ensure payment for emerging standards of care such as cystoscopy. But no new CPT codes will be approved and validated unless gynecologic surgeons start getting involved in the reimbursement battle.