The American College of Radiology (ACR) held a session regarding the current process of reimbursement for new technologies and procedures through CPT (Current Procedural Terminology) codes and the development of these codes at the Radiological Society of North America (RSNA) annual conference in Chicago last week.
Richard Duszak, MD, of the Pennsylvania Radiology Society and an ACR fellow, opened the session by discussing the current CPT code process.
Duszak explained that any service received by a patient--including medical, surgical and diagnostic services--is translated into a code that appears on the payer’s claim form. The same codes are used by all practitioners, which are then used by the payers to determine the amount of reimbursement that a practitioner will receive for the procedure or service.
Despite the uniformity ensured by the codes, Duszak said that that the “payment system has become more hostile.”
“[Practitioners] used to have wiggle room. Now, the CPT code selection process has gotten more accurate, so the wiggle room has been taken away,” he said.
As a member of the ACR’s Commission in Economics, Duszak explained that adequate, existing codes are a good choice for the practitioner. Current code instructions tell practitioners to select the procedure of service that most accurately identifies the service. Duszak noted, however, that there may not be a perfect match. Therefore, the commission is currently being pushed forward into making new codes and accepting new code applications as technology advances.
Duszak explained the CPT code editorial process that each new application for a code must follow. First, the American Medical Association (AMA) reviews the application from an editorial standpoint, “making sure the i’s are dotted and the t’s are crossed,” said Duszak.
The new code application then moves on to the CPT advisory committee, consisting of one representative from each of the 120 specialties represented in the AMA House of Delegates. Duszak stated that this committee decides whether the new code has merit or whether it can be improved. Next, the application moves to the CPT editorial panel.
“Ultimately, the CPT editorial panel is the final decision-making body and votes as to what goes in the CPT book each year,” said Duszak. The panel includes 17 members-all of whom have been appointed by the AMA board of trustees. Currently, the members include two representatives from the Healthcare Professionals Advisory Committee, one physician assistant and a clinical psychologist, as well as two representatives of various payor groups and 11 physician representatives of various expertises.
A change that Duszak noted within the panel is that “radiology is not guaranteed a seat at the table.” Currently, however, two of the 11 physician representatives are radiologists.
With radiology consisting of one of the 120 seats on the CPT advisory committee, Duszak said that the ACR is very involved in CPT activity.
On average, there are 500-600 code changes that take place every year. Of these, 200 are new codes--with 85 of these codes pertaining to radiology. Of the 100 code deletions, an average of 22 concern radiology and approximately 47 of the 200 editorial revisions that take place every year are in regard to radiology.
Duszak concluded by advocating for more radiology representation in the CPT coding process.