As covered in a previous entry, the American Medical Association’s (AMA) Current Procedural Terminology (CPT) is the basis for a medical coding and billing system that is used by professionals throughout the health and medical services industries. According to the AMA, its CPT coding procedures comprise the most widely accepted system in public and private health insurance. The Centers for Medicare and Medicaid Studies (CMS) – the federal agency that oversees these programs – also makes use of CPT in its coding system.
CPT works by defining a vast array of health or medical procedures and assigning a code and value to each one of these. Health care providers can then accurately and quickly describe a procedure that has been performed and efficiently apply for reimbursement for a given procedure with a patient’s insurance company. In turn, the insurance company is also familiar with CPT.
Periodically the AMA develops a revised and updated version of its CPT. For 2015 this has meant more than 500 changed or new codes that have been introduced into the CPT, a larger-than-usual amount. There are six medical fields in particular that will be affected most by the changes:
- Family practice
- Lab pathology
- Internal medicine
CPT codes are divided into three basic categories: procedural, patient services, and emergent treatments. Of the added, modified, and deleted codes in the 2015-edition of the CPT, most of the changes occurred in the procedural category, with relatively fewer in the emergent treatments category and hardly any in the patient services category.
How CPT Codes Are Determined
Although the American Medical Association (AMA) is ultimately the agency that determines and issues its CPT, this set of codes would not be as widely used as it is today – and as it has been for four decades – were it not for consultation with insurance companies and health care providers from across the nation. Specifically, it is the CPT Editorial Panel that is tasked with creating and maintaining CPT.
The CPT Editorial Panel takes its authority from the AMA’s Board of Trustees and is comprised of 17 members:
- 11 of these panel members are physicians who are approved by the AMA and nominated by the National Medical Specialty Societies
- The Blue Cross and Blue Shield Association nominates one physician to the panel
- America’s Health Insurance Plans nominates one physician to the panel
- The American Hospital Association nominates one physician to the panel
- The Centers for Medicare and Medicaid Studies (CMS) nominates one physician to the panel
- Two panel seats are allocated to members of the CPT Health Care Professionals Advisory Committee
Panel members represent the interests of their delegating associations and make collaborative decisions with their peers. In order to ensure a healthy exchange of ideas within the medical community and associated fields, the CPT Editorial Panel will also convene at least three annual meetings in an open process where professionals from more than 100 agencies have the opportunity to offer their input.
Additionally, any interested party can submit a code change request by turning in the appropriate form to the AMA. Each of the three general CPT categories has its own criteria that assigned codes must meet. The CPT Editorial Panel will review requests to change or add codes based on criteria that is well established.