How are musculoskeletal CPT codes created and revised ?
How are musculoskeletal CPT codes created and revised ? |
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By Daniel H. Sung, JD
Physicians’ Current Procedural Terminology (CPT) is a
publication maintained by the American Medical Association
(AMA) that contains a list of terms that describes medical
services and procedures. CPT provides a uniform “language”
that allows physicians to describe the medical, surgical and
diagnostic procedures they perform in everyday practice. CPT
is an important system for physicians to understand because
almost all health insurance payers (including Medicare) use it
as a reporting tool in the reimbursement
process.
CPT Editorial Panel
The
CPT Editorial Panel is responsible for maintaining CPT. The
panel is made up of representatives from the medical
community, private insurance, hospitals and Medicare. They
meet four times each year to revise and modify CPT to make
sure it represents current medical practice. The panel met
Nov. 6 – 8, 2003, to discuss dozens of revisions and additions
to CPT.
An updated version of CPT is published each
year that reflects all changes made by the editorial panel.
CPT 2004 is available now for purchase, but this edition will
not become effective until Jan. 1, 2004.
CPT
Advisory Committee
The CPT Advisory Committee
provides support to the Editorial Panel in maintaining CPT.
The Advisory Committee is made up of representatives from many
of the medical specialty societies in the AMA House of
Delegates. The primary role of this group is to serve as a
year-round resource to the CPT Editorial Panel by providing
advice on procedure coding, providing documentation on the
medical appropriateness of procedures under consideration for
inclusion in CPT, suggesting revisions to CPT and assisting in
the review and development of educational material. In
addition, the Advisory Committee meets once a year to discuss
current coding issues.
At last meeting on Nov. 7, 2003,
the CPT Advisors panel discussed a variety of topics including
online evaluation and management (E/M) services, the
development of workers’ compensation CPT codes and the use and
application of CPT Category II (performance measurement)
codes. The committee also heard presentations on projects such
as the development of a sophisticated search program that will
allow users to search CPT electronically and a presentation on
McKesson’s process of developing coding
edits.
CPT Process
Anyone may
submit a coding proposal to the Editorial Panel. A complete
proposal will include a detailed discussion of the proposed
revision, addition or deletion from CPT. If the proposal is
for a new code, it is necessary to document and establish the
clinical efficacy of the procedure and to show the procedure
is performed frequently across the country. Once the proposal
is submitted, the members of the CPT Advisory Committee review
and comment on the proposal. Finally, based on the
recommendations of the CPT Advisory Committee, the Editorial
Panel deliberates on whether to accept a coding proposal. If a
proposal is accepted, it is incorporated into the next edition
of CPT.
The Academy’s CPT and ICD Coding Committee is
active in the CPT process because it continually monitors and
develops code proposals that benefit orthopaedics. The
committee is currently working on five musculoskeletal coding
proposals that will convert existing Category III CPT codes
into Category I CPT codes. The proposals include conversion of
codes for arthroscopically-aided meniscal allograft,
arthroscopic osteochondral autograft, autologous chondrocyte
implantation of the knee, open osteochondral allograft and
arthroscopic osteochondral allograft.
In addition, the
Academy’s Coding Committee strongly suggests you contact them
if you are interested in submitting a coding proposal that
revises, adds or deletes a code from CPT because the committee
has many years of experience in developing proposals. The
committee is made up of representatives from 13 different
musculoskeletal societies, so it has complete representation
across all of orthopaedics. In addition, three CPT Advisors
sit on the Academy’s CPT and ICD Coding Committee. Finally,
all of the members of the committee are experts with extensive
coding experience and knowledge. In sum, the Academy’s Coding
Committee is a vast coding resource that can help Academy
members navigate through the CPT process.
For
more information on coding issues,
contact AAOS department of socioeconomic & state
society affairs at (847) 384-4320.