Earning a seat on the CPT Editorial Panel
Ask the Expert
By Richard Nelson, Editor, January 1, 2025
DermWorld interviews Scott A. B. Collins, MD, FAAD, FACMS, who represented dermatology at the AMA Relative Value Scale Update Committee (RUC) from 2006 until recently, about his appointment for a four-year term on the CPT® Editorial Panel.
Dr. Collins: I had the privilege to be a member of the RUC, representing dermatology, for 12 years. The RUC is a committee made up of members from across medicine who advise the Centers for Medicare & Medicaid Services (CMS) on the relative value units (RVUs) — a metric used in Medicare to determine payment rates for all physician services. Although the process is not perfect, it’s important because it gives physicians a voice in valuing the work and intensity of their services, helping ensure that these valuations accurately capture the complexities involved in delivering care. Without it, there isn’t a current process that allows physicians to provide input on the valuation of services. While CMS makes the final decisions about how many RVUs are assigned to an individual code, the recommendations of the RUC are followed an average of 90% of the time, and in the cases where they’re not, sometimes the variation may be a few hundredths of an RVU.
Before being appointed as a RUC member, I served as an observer and then as a specialty society RUC advisor for seven years. Dermatology, like every specialty, has a team of RUC advisors representing the specialty’s interest throughout the RUC process. As a RUC member, I did not directly interface with the RUC advisors, but I can tell you that they are diligent in defending specialty-specific codes at the RUC and committed to ensuring the outcome is fair and accurate.
DermWorld: What have your most memorable and valuable RUC experiences been?
Dr. Collins: The intensity of the RUC process leads to the formation of intensely close and enduring relationships both within the team and among the other members of the house of medicine who are in the room. I value the friends I’ve made during my years of service — I’ve helped nurse one’s goat on his farm and had BBQ with another.
I’ve also learned a lot. The RUC has a clearly defined agenda; except in very limited circumstances, it cannot put things off to the next meeting. This teaches every participant how to stick to the agenda, stay on task, and accomplish immense amounts of work in a fixed time period. As a result, when the RUC meeting ends you can feel very satisfied looking back at everything that we got done. Learning that skill set of hyper-efficiency and productivity makes you better at the rest of your life. You’ll be a better committee member, a better advocate, even a better friend. You learn how to get things done effectively but respectfully.
DermWorld: How can Academy members support the work of dermatology’s RUC team?
Dr. Collins: If you get a RUC survey, don’t staff it out. Fill it out yourself. Realize it’s not a competition so don’t just consider your fastest case. List your typical case. It’s important, if you’re selected to fill out a survey, to think of all the things you do that have become almost automatic. You may see a patient and immediately process a huge number of visual clues to narrow your diagnosis; that’s not the entire time spent with that patient. Think about all the steps — there are a lot involved in doing a procedure properly, from identifying the proper instrument, to picking it up safely, to positioning it properly within the operative field. All the time for all of those bits is part of procedure time.
Another way you can help is by making sure you portray the work of dermatologists accurately. Comments or videos on websites talking about procedures should not be shined-up to make them more acceptable to patients. They should be honest. Don’t post a video suggesting that something takes 10 seconds because you skip steps of something that takes 10 minutes. If you are going to edit parts out, you should make that very clear. Posting instructional videos is great! But please annotate to indicate that the video has been edited for content and time.
DermWorld: What does the CPT Editorial Panel do? How were you selected to serve?
Dr. Collins: The CPT Editorial Panel creates codes and descriptions for new medical procedures or technologies for inclusion in the Current Procedural Terminology code set. Those are the codes for which RUC submits recommended values to CMS, along with any revaluation recommendations for older codes. CPT also revises existing code descriptors to be more accurate and to match current medical practice.
Being selected to serve involved being nominated, seeking recommendations, and ultimately having my selection approved by the American Medical Association Board of Trustees.
DermWorld: How does being on the CPT Editorial Panel differ from serving on the RUC?
Dr. Collins: The CPT Editorial Panel is a more collaborative process between the panel and presenters; everyone wants to get a code descriptor that accurately describes the physician work being done.
I believe that having RUC experience will make me useful on the panel; I intend to work to make sure that code descriptors are created in a way that the RUC can most accurately value them. I’m not the first RUC person to go to CPT, but it happens rarely, and I look forward to bringing my experience to the panel.
DermWorld: What do you hope your fellow dermatologists learn from your experiences with the RUC and the CPT Editorial Panel?
Dr. Collins: It has been one of the best experiences of my life to serve on the RUC; I’m incredibly grateful and humbled by the opportunities I’ve had to help as both a partisan for dermatology and as a member serving the house of medicine. It’s a tremendous honor.
I also hope my colleagues can see from my experience that you can be a private practice dermatologist and make an amazing difference. I’m not an academic with hundreds of publications or the president of any society. But I’ve been able to serve our specialty on the RUC — a role I’ve found incredibly rewarding. I hope others see this example and are inspired to make a difference as well.
AAD/A Impact Report
Read more about what the Academy is doing for you at staging.aad.org/impact.
