December 2003 Bulletin

How are musculoskeletal CPT codes created and revised ?

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.

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