Law Summary
Additional Compensable Surgical Procedures and Corresponding RVUs
- The circular introduces new surgical procedures as addenda to the RVS 2001.
- Each procedure is identified by a unique code, descriptive term, and its assigned relative value units (RVU).
- Procedure examples include:
- Mastectomy for gynecomastia (Code 19140; RVU 30)
- Closed treatment of coccygeal fracture (Code 27200; RVU 90)
- Suture of tracheal wound – cervical (Code 31800; RVU 50) and intrathoracic (Code 31805; RVU 200)
- Temporary transvenous pacing electrodes insertion/replacement – single chamber (Code 33210; RVU 50) and dual chamber (Code 33211; RVU 50)
- Exchange transfusion, blood (Code 36450; RVU 20)
- Secondary suture of abdominal wall for evisceration or dehiscence (Code 49900; RVU 100)
- Colposcopy (Code 57452; RVU 10)
- Replacement or revision of cerebrospinal fluid shunt (Code 62230; RVU 80)
- Intraocular lens procedures, including repositioning and insertion/exchange (Codes 66825, 66985, 66986; RVUs 90 or 130)
- Cerebral angiography (Code 75665; RVU 50)
Revised RVUs for Appendectomy and Cholecystectomy
- The circular revises the RVUs for appendectomy and cholecystectomy procedures, including laparoscopic methods:
- Appendectomy (Code 44950; RVU 100)
- Cholecystectomy (Code 47600; RVU 180)
- Laparoscopic appendectomy (Code 56315; RVU 100)
- Laparoscopic cholecystectomy (Code 56340; RVU 180)
Modifications to Radiation Treatment Delivery Codes
- The circular amends the use of RVS code 77401, previously assigned for radiation treatment delivery.
- Effective for claims with discharge dates from January 1, 2003:
- Code 77401 is designated exclusively for external beam radiation treatment delivery (e.g., Cobalt or Linear Accelerator), with RVU 10.
- A new code, 77761, is introduced for brachytherapy procedures (radioelement application: surface, interstitial, or intracavitary), assigned RVU 20.
Legal and Operational Implications
- The circular clarifies that all other circulars consistent with these amendments remain valid and effective.
- It emphasizes adherence to the updated codes and RVUs for claims processing from the specified discharge dates.
- The circular was officially adopted on December 12, 2002, under the authority of the PhilHealth President and CEO, Dr. Francisco T. Duque III.