Changing The CPT Outpatient Coding Guidelines

time for changeDo you as a physician or healthcare provider actually have time to manage the medical coding portion of your practice or facility? CPT codes are always changing and you medical coders MUST keep up with these changes, either on your time or their own. Do you know if they are?

As of January 1, 2013 outpatient coding for behavioral health providers and payors changed. Since this affects so many people, who makes these codes and what is the process that happens during this change?

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While the average patient may not understand all these codes on their EOB, the AMA first published the Current Procedural Terminology in 1966. The purpose behind the creation of CPT was to provide a uniform language facilitating reliable nationwide communication standards among physicians, healthcare providers, patients and third parties.  The development of medical coding provides an accurate description of medical, surgical, and diagnostic services. This keeps everyone involved in maintaining health care records management on the same page with regards to what everyone is “calling” a particular procedure or diagnosis. It is an easier, more complete way for medical coding and billing technicians to request the appropriate reimbursement for the healthcare providers as well.

The actual editorial panel of 17 members is responsible for the actual maintaining of CPT used by medical coders, but there is a much larger body, called the CPT Advisory Committee. The members of this committee are primarily physicians nominated by the national medical specialty societies represented in the AMA House of Delegates. Additionally, a group of individuals, the Performance Measures Advisory Group (PMAG), who represent various organizations concerned with performance measures, also provides expertise.

The Advisory Committee meets annually at the CPT Fall meeting to discuss items of mutual concern and to keep abreast of current issues in coding and nomenclature. When they meet they review documentation regarding the medical appropriateness of various medical and surgical procedures under consideration for inclusion in CPT and make appropriate recommendations to the editorial panel.

In addition to reviewing inclusions to the CPT, the committee assists in the review and further development of relevant coding issues and in the preparation of technical education material and articles pertaining to CPT.

Medical coding companies, as well as any interested party, can submit an application for changes to CPT for consideration by the Editorial Panel, these requests are then reviewed by the AMA’s CPT staff. If it is determined that the issue has already been reviewed or addressed, the application does not go any further in the process. However, if the staff determines that the request presents a new issue or significant new information on an item that the Panel reviewed previously, the application is referred to members of the CPT Advisory Committee for evaluation and commentary.

The editorial panel meets three times a year, and some medical coding categories change often because of it. This creates issues for medical coding specialists if they do not stay abreast to the ever-changing world of CPT. Medical coding companies hire coders who are up to date with their training, certification and can prove that they are ready to be placed in a position that requires a vast amount of knowledge about health care records management.

While the CPT affects so many people, those who are most affected are the medical coding specialists who facilitate the communication between all parties involved.