CPT-5


CPT-5

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The AMA’s theme to revising CPT is “Evolution, Not Revolution,” and the change has already begun, yet so slowly, only the most observant will notice.

The American Medical Association (AMA), which created and maintains the copyright on CPT, has publicized the advent of its “new and improved” coding system, dubbed CPT-5. But if you are waiting for an announcement of when the new system will be officially unveiled, think again.

The AMA’s theme to revising CPT is “Evolution, Not Revolution,” and the change has already begun, yet so slowly, only the most observant will notice.

CPT began evolving as early as 1999 and change continues in this year’s edition. The timeline calls for the rollout of revisions to be completed by the 2003 edition.

First came a change in name. In 1998, the official name of the book was Physicians’ Current Procedural Terminology. This changed in 1999 to Current Procedural Terminology, in recognition of the fact that many allied health professionals also use CPT codes. This small change is symbolic of the overhaul that the AMA is performing, in hopes of transforming CPT into the eclectic, comprehensive coding system for the 21st century.

CPT codes are required on most government and commercial payer medical claims to describe services performed. The codes are created by the CPT Editorial Panel, comprising specialty physicians and representatives from the AMA, which also seeks advice from advisory committees of physicians and other health care professionals. Decisions on new procedural codes are made in closed meetings, as the AMA is a private organization and not held to government sunshine laws. The codes have been updated annually to reflect advances in medical science, but the CPT-5 project is considered more than an annual update.

Because the last major revision of CPT was called CPT-4, this revision is called CPT-5, but the name of the actual codebook will not change. The goals of the AMA in its CPT-5 initiative are to:

  • Preserve core attributes of CPT-4. This means the five-digit numeric code would continue, and the basic ordering of specialties would likely remain the same in CPT. Modifiers would still be used.
  • Eliminate ambiguities/inconsistencies. The language of CPT is currently not consistent, and the AMA’s goal is to improve this. For example, look at how nomenclature for ovary removal and how laterality are handled in these two codes: 58150 Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); 58950 Resection of ovarian, tubal, or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy
  • Enhance index. Expansion of the index at the back of CPT began in 2000, and continues this year. For example, nine entries were added between index entries Antigen and Antigen Detection between editions in 1999 and 2001.
  • Increase specificity. In order to use CPT codes to track outcomes, the codes need to be more specific about what is included in the procedure. This year, the AMA began the process of clarifying many codes. For example, proton beam treatment delivery was described in two codes in CPT 2000, but for 2001, there are now four codes to choose from. Added for clarity is information on whether the procedure is simple, intermediate or complex, and whether compensators are included. Also added for 2001 is narrative clearly defining these terms.
  • Delete global surgical package. The global surgical package is the pre- and postoperative care that is considered part of a surgical procedure. It is never reported or paid separately. Because pre- and postsurgical requirements vary greatly from patient to patient, the AMA seeks to change this rule in CPT so that each component of preoperative and postoperative care would be separately reported.
  • Delete starred procedure and separate procedure conventions. Like eliminating the global surgical package concept, eliminating these concepts would simplify coding rules and streamline coding processes.
  • Add special codes to track HEDIS measures and to track new technologies. These codes would not be part of the conventional CPT code set, but additional code sets consisting of four numbers followed by an alpha kicker (1234A). HEDIS stands for Health Plan Employer Data and Information Set, a set of standardized performance measures for physician services. For example, annual diabetic retinal exam is considered a standard performance measure, as are childhood inoculations. Physician care is evaluated based on a HEDIS “report card” that determines how consistently the physician is performing these preventative medicine standards, but currently, chart audits are required to gather the information needed for HEDIS audits. Codes would allow easier tracking of HEDIS measures and also tracking of new technologies to determine their efficacy.

According to CPT Assistant, Volume 10, Issue 2, “The primary objective of the CPT-5 Project is to maintain CPT as the authoritative source of correct procedural coding for the health care community and to insure (sic) that CPT is the U.S. and international procedural coding nomenclature that facilitates reimbursement and analysis of health care information.”

The advances to CPT are also thought by the AMA to guard against a national conversion to ICD-10-PCS, a revolutionary procedural coding system developed for the federal Health Care Financing Administration (HCFA) by 3M Health Information Services. ICD-10-PCS is designed to replace Volume 3, the procedural coding portion of ICD-9-CM, used for hospital procedural reporting. ICD-10-PCS is a seven-character coding system that uses both numeric and alpha characters. The popular expectation is that it would be implemented for hospital procedural reporting at the same time ICD-10-CM is implemented for diagnostic coding. However, there has also been some discussion that only one of the two procedural coding systems would ultimately survive for reporting both inpatient and physician services in the United States.

ICD-10-PCS enjoys the favor of being a publicly owned coding system, evaluated and altered in public meetings. It also has an enormous untapped capacity because it uses seven characters and incorporates alpha characters along with the numbers. CPT enjoys favor because it is the system we have been using successfully for decades, has the support of AMA membership, and doesn’t require a change in software standards or staff training to be effective.

Sheri Poe Bernard is a member of the American Academy of Professional Coders (AAPC) National Advisory Board, president-elect of the Pro-Tulsa Chapter of AAPC, and director of essential regulatory products for Ingenix, the parent organization of St. Anthony Publishing and Medicode.

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