opinion

Let’s take off our hats to the CPT Editorial Panel

A message to all physicians from Steven J. Stack, MD, chair of the AMA Board of Trustees.

By Steven J. Stack, MD , an emergency medicine physician in Lexington, Ky., was chair of the AMA Board of Trustees during 2012-13. Posted Nov. 12, 2012.

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As many of you now know, I am a staff emergency physician, and I try to write my columns using real examples from my professional work. I hope that discussing a diversity of issues from my personal experience lends credence to my observations.

Today, I want to talk about an issue that affects every physician and every practice: Current Procedural Terminology, or CPT, the terms and identifying codes that provide a uniform language to accurately describe medical, surgical and diagnostic services. CPT provides an effective means of reliable communication among physicians, patients, researchers, public health officials and others.

In October, I attended a meeting of the CPT Editorial Panel to learn more about this essential process. During the course of three multiday meetings each year, hundreds of our colleagues from across the family of medicine volunteer their time and insights to ensure that the clinical care and services we provide are clearly and accurately described.

CPT Editorial Panel meetings generally attract about 300 people. The gathering fills a hotel ballroom, captures broad participation and is inclusive. In fact, every CPT Editorial Panel meeting is open to anyone who wants to attend.

The panel itself has 17 members. Of those, 11 are physicians nominated by their national medical specialty societies and approved by the American Medical Association Board of Trustees. In addition, one physician each comes from the BlueCross BlueShield Assn., America’s Health Insurance Plans, American Hospital Assn. and the Centers for Medicare & Medicaid Services. The final two seats are reserved for members of the CPT Health Care Professionals Advisory Committee. Right now, the panel includes a pediatrician, family physician, cardiologist, radiologist and neuropsychologist, among others.

A much larger body, the CPT Advisory Committee, is made up of more than 100 more individuals — physicians nominated by national medical specialty societies and members of the AMA Health Care Advisory Committee.

As a first-time attendee, I was struck by the dedication and earnestness of the physicians and other health professionals who were present at the October meeting. Each of the physicians I spoke with shared his or her feeling about the vital importance of what they were doing. In one way or another, they all told me, “Practicing physicians know best about what is involved and what it takes to provide patient care. Physicians must be the ones who make these decisions about coding.”

I couldn’t agree more. Can you imagine a group of bureaucrats or businessmen trying to describe what we do as physicians? I shudder at the thought.

CPT panel members and advisers are unpaid volunteers, yet their work ethic and commitment is complete. They spend many hours in personal preparation followed by multiple days at in-person meetings discussing the subtleties of a service or procedure. The CPT Editorial Panel meetings can be intense, detailed and nuanced. They are not for the casual observer.

The CPT panel is on my short list of one of the most important but least understood and appreciated physician volunteer activities anywhere. CPT codes are a common language, written by and for physicians and health care professionals to accurately and consistently describe medical, surgical and diagnostic services. “Steve,” as one colleague said to me, “who better to do this than physicians?”

Sometimes the panel meetings focus on refining small changes that have been pointed out by CPT Advisory Committee members; sometimes the panel develops codes for whole new areas.

One of the largest recent expansions to the CPT code set reflects advancements in understanding the molecular basis of disease, including the Human Genome Project. New CPT codes for molecular pathology tests first appeared in the CPT 2012 code set, and the evolving process has resulted in the creation of 116 molecular pathology codes that are now incorporated into the 2013 CPT code set.

Other CPT changes for 2013 reflect physician practice changes and technology improvements in cardiology, neurologic testing and psychiatry.

CPT codes also have been updated to better support the reporting needs of physicians and others who are participating in emerging models of care, such as a patient-centered medical home, accountable care organization and other novel integrated delivery systems. While codes for some of these care coordination services already were available, the new care coordination codes for 2013 allow medical practices to efficiently report time that is spent connecting patients to community services, transitioning them from inpatient to other settings and preventing readmissions. This is a significant addition — and a good one.

Moreover, as we focus more and more on taking cost out of our health system, keeping CPT codes accurate and current is an important part of the larger effort.

Before CPT’s universal adoption in 1983 under the Reagan administration, the health care system struggled to cope with multiple code sets for reporting procedures, most of which had inadequate input from the medical profession. At that time, when the Health Care Financing Administration decided to accept a physician-developed system, the AMA developed the CPT process that is followed today and includes the CPT Editorial Panel and larger CPT Advisory Committee.

Most physicians know that the AMA does not charge the government for either development or use of CPT codes. The income we do receive from the sale of CPT materials, though, makes possible the important work the AMA does in medical ethics, research, education and other areas that might otherwise go undone. I cannot imagine that either the government or a private company would produce the same careful results that come from our volunteer colleagues.

Using the CPT code set to track patient treatment information is certainly not the most important part of being a physician. But the code set is the foundation upon which every element of the medical community — doctors, hospitals and allied health professionals, laboratories and payers — can keep and share accurate records, submit and process timely insurance claims and, most importantly, maximize the amount of time devoted to patient care.

To the physicians I met earlier this month at the CPT Editorial Panel meeting, I take my hat off to you.

We appreciate what you do.

Steven J. Stack, MD , an emergency medicine physician in Lexington, Ky., was chair of the AMA Board of Trustees during 2012-13.

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