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PubMed1993

Current procedural terminology coding of nuclear medicine procedures.

The future of nuclear medicine is dependent on payment for new procedures. Today, the basis of payment by the federal government is a relative value unit (RVU) system; the RVUS employed in this system are for medical services and procedures listed and described in Physicians' Current Procedural Terminology, fourth edition. Current procedural terminology (CPT) is maintained by the AMA; annual revisions include adding new codes or revised or deleted old codes. This process involves all national medical specialty societies. Starting in 1992 a new process, the Relative Updating Committee, which was initiated by the AMA, organized medicine to formalize a method for recommending relative values for physician procedures and services. In this rapidly changing scenario, all nuclear medicine procedure codes are under review by the coding and nomenclature committees of the medical societies interested in imaging. Significant CPT changes and additions were made in the cardiovascular nuclear medicine codes in 1992, reflecting the current imaging protocols and pharmacological agents for performing cardiac stress testing and new codes that recognize combinations of ventricular function measurements in patients undergoing myocardial perfusion imaging with technetium-99m agents.

American Medical Association↗
PubMed1989

Current procedural terminology codes for psychiatric services.

Physicians' Current Procedural Terminology (CPT) is the system most commonly recognized by third-party payers for describing medical services in numerical codes for subsequent reimbursement. Adequate description of psychiatric services using CPT codes is an ongoing challenge. Psychiatrists have responded to the demands of third-party payers and peer review organizations for documentation and accountability by billing for specific services rather than by designating all care as psychotherapy. The authors present guidelines for using CPT codes to describe inpatient and outpatient psychiatric services and consultation. They also discuss continuing controversies, including regional diversity in the interpretation of codes by third-party payers, the risks of "gaming" the coding process, and the use of CPT codes by non-physician providers and the consequent mixing of data on service charges.

Abstracting and Indexing↗
PubMed2002

Valuing neurosurgery services: part I. The historical development and interrelationships of current procedural terminology and the medicare fee schedule.

Current Procedural Terminology (CPT) standardizes medical procedure coding for billing and reimbursement. Since adoption of CPT coding as the basis for the Medicare Fee Schedule (MFS) in 1992, CPT coding policies and policy changes have been influenced not only by medical necessity and customary practice, but also increasingly by Medicare payment policies. The MFS created regulatory price control in the United States medical market based on widespread adoption of modified MFS by private payers and benchmark MFS fees governed by federal budget limitations and set annually by government agency (Centers for Medicare and Medicaid Services).

Fee Schedules↗
PubMed2002

Valuing neurosurgery services: part II. The interdependence of Current Procedural Terminology and federal Medicare payment policy.

Current Procedural Terminology (CPT) policies for coding of medical procedures and services are adopted by the American Medical Association CPT editorial panel. Since institution of the Medicare Fee Schedule in 1992, the Medicare budget neutrality rule has strongly influenced CPT policies for the coding of additions or modifications. The Centers for Medicare and Medicaid Services Medicare program policies, particularly payment limits, influence code modification strategies and CPT editorial panel processes.

Fee Schedules↗
PubMed2006

Billing effectively with the new health and behavior current procedural terminology codes in primary care and specialty clinics.

The health and behavior current procedural terminology (CPT) codes introduced in 2003 have gained nationwide acceptance through Medicare and limited acceptance through third party payers. The codes facilitate accurate description and quantification of behavioral medicine services within a primary care or specialty clinic setting. The author reviews their appropriate utilization to enhance reimbursement and facilitate development of self-sustaining behavioral medicine programs. Information is provided on increased use and reimbursement of codes within psychology. Future directions for continued advocacy, increased acceptance, training, and research are discussed.

Behavioral Medicine↗
PubMed2005

The new apheresis and blood and marrow transplantation-related current procedural terminology codes for payment of apheresis and blood and marrow transplantation services.

To address deficiencies in Current Procedural Terminology (CPT) codes that describe many of the clinical services offered to patients, several physicians in the blood and marrow transplantation and apheresis field joined with a coalition including the American Society of Hematology, American Society for Blood and Marrow Transplantation, American Association of Blood Banks, American Society of Clinical Oncology, American Society for Apheresis, National Marrow Donor Program, and American Red Cross to collaborate in addressing these deficiencies by designing new CPT codes. The CPT editorial panel approved 18 new or revised codes. All these codes were given permanent or temporary value by the relative value unit update committee, but not all values were approved by the Centers for Medicare & Medicaid Services (CMS), in particular, the cell-processing codes and the unrelated donor search code. Further discussions addressing these concerns are under way with the CMS. Use of these new codes allows apheresis and transplant centers to charge appropriately for these services. This will help transplant center contracts with CPT codes, with payers more specifically describing services offered to these patients. In turn, this will give better justification for payment. This may allow certain payments for services to increase and help transplant centers better allocate revenue from fixed global case rate payments. Details about the individual codes and their approval process are reviewed in this article.

Blood Component Removal↗
PubMed2002

Expert agreement in Current Procedural Terminology evaluation and management coding.

BACKGROUND: Available data suggest that physicians are accurate in approximately 55% of Current Procedural Terminology (CPT) evaluation and management (E/M) coding for their services. This accuracy is relative to observers' or auditors' assigned codes for these services, a group that has not been studied for their consistency in application of the CPT E/M coding guidelines. The purpose of this study was to determine the level of agreement of certified coding specialists in their application of CPT E/M coding guidelines. METHODS: Three hundred certified professional coding specialists randomly selected from the active membership of the American Health Information Management Association were sent 6 hypothetical progress notes of office visits along with a demographic survey. The study group assigned CPT E/M codes to each of the progress notes and completed the demographic survey. RESULTS: Coding specialists agreed on the CPT E/M codes for 57% of these 6 cases. The level of agreement for the individual cases ranged from 50% to 71%. Relative to the most common or consensus code, undercoding of established patients occurred more commonly than overcoding. In contrast, for new patient progress notes, overcoding relative to the consensus code was more common than undercoding. CONCLUSIONS: There is substantial disagreement among coding specialists in application of the CPT E/M coding guidelines. The results of this study are similar to results of prior studies assessing physician coding accuracy, suggesting that the CPT coding guidelines are too complex and subjective to be applied consistently by coding specialists or physicians.

Adult↗
PubMed2002

Reliability of assigning correct current procedural terminology-4 E/M codes.

STUDY OBJECTIVES: We determine the degree of interagency and intra-agency agreement on Current Procedural Terminology-4 (CPT-4) coding levels for emergency department medical records. We hypothesized that the level of agreement among coding agencies would be poor, but the distribution of codes would be similar and not significantly different. METHODS: We performed a prospective observational study consisting of 3 separate randomized, blinded trials: 2 interagency comparisons and 1 intra-agency comparison. The setting was 2 suburban academic EDs. In the 2 interagency audits, 4 coding agencies were used. In the intra-agency comparison, we used 5 individual coders from within our own internal agency. The main outcome measures were the level of agreement not due to chance estimated with the multiple-rater weighted kappa statistic and the Kendall tau-b. We measured the distribution of codes by agency or by individual coders with the chi(2) test. RESULTS: Our sample for the 2 interagency audits consisted of 194 and 195 records, respectively. We observed poor agreement in the level of coding assigned to individual charts among the 4 coding agencies, with kappa values of 0.28 (95% confidence interval [CI] 0.275 to 0.285) and 0.287 (95% CI 0.283 to 0.291). Our intra-agency comparison consisted of 100 records. The agreement in the intra-agency review was significantly better but still fair (kappa=0.436; 95% CI 0.428 to 0.444). The distribution of CPT-4 codes was significantly different for all 3 comparisons (P <.001). CONCLUSION: For our patient population, group of physicians, and methods of documentation, we identified poor-to-fair agreement in coding of emergency charts between coding agencies. Only fair agreement was measured in the intra-agency sample. The distribution of assigned CPT-4 codes was significantly different in each comparison. These findings have important financial and legal implications regarding the reliability of coding methods.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Current procedural terminology, Resource-based Relative Value Scale, and the Center for Medicare and Medicaid Services: overview.

Coding and payment methodology for physician professional services has been standardized through the introduction of the Current Procedural Terminology, which is maintained by the American Medical Association. The codes contained within this dataset are used by health care professionals to describe their services to payers. Inherent in the development of the procedural codes, the Resource Based Relative Value Scale Update Committee recommends physician work relative value units and practice expense and professional liability inputs to the Center for Medicare and Medicaid Services. This article provides an overview of the processes in place that permit regular updates in physician payment continually to be updated.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1997

Comparison of nursing interventions classification and current procedural terminology codes for categorizing nursing activities.

PURPOSE: To compare the frequency with which nursing activity terms could be categorized using Nursing Interventions Classification (NIC) and Current Procedural Terminology (CPT) codes. DESIGN: Descriptive. The sample was 201 patients with AIDS hospitalized 1989-1992 for pneumocystis carinii pneumonia in three US medical centers. METHODS: Nursing activity terms (n = 21,366) were collected from patient interviews, nurse interviews, intershift reports, and patient records, then were categorized using NIC and CPT codes. RESULTS: Nursing activity terms were categorized into 80 NIC interventions across 22 classes and into 15 CPT codes. All terms in the data set were classifiable using the NIC system and the majority (60%) of the terms were classified into 14 NIC intervention categories; 6% of the terms were classifiable by CPT codes. The most frequently used CPT code was "pulse oximetry." Significantly (p < .0001) greater numbers of nursing activity terms could be categorized in the NIC system compared to the CPT system. CONCLUSIONS: Findings provide evidence that NIC is superior to CPT for categorizing nursing activities in this study's population. The findings support the importance of discipline-specific classifications for categorization of health care interventions. Nursing-specific intervention classification systems such as NIC, the Omaha System, and the Home Health Care Classification are essential to defining the contribution of nursing to both quality and cost outcomes.

Adult↗
PubMed2004

A survey of clinical productivity and current procedural terminology (CPT) coding patterns of pediatric hematologist/oncologists.

BACKGROUND: Subspecialty-specific normative values for clinical productivity of practicing pediatric hematologist/oncologists have not been well established. This information could be a useful adjunct in administrative decision-making in areas such as necessary levels of physician staffing and development of compensation plans. METHODS: Current procedural terminology (CPT) coding information was obtained from 27 pediatric hematology/oncology groups. Clinical productivity was assessed by overall number of patient encounters and the total number of physician work relative value units (RVU) as defined by the resource-based relative value scale. The average physician productivity within each individual program was calculated. To determine uniformity of CPT coding, an additional survey solicited mock patient encounter documentation and CPT coding for a simple clinical vignette. RESULTS: A broad range of clinical productivity was observed for both numbers of patient encounters and RVU. Evaluation of the CPT coding data of the surveyed groups revealed differences in usage of certain evaluation and management (E/M) codes and procedural and specimen interpretation codes. Within individual categories of E/M service codes, a wide variation in assigned CPT code levels was also observed. This observation was supported by differences in the E/M coding for the clinical vignette. CONCLUSIONS: Assessment and tracking of physician productivity can provide useful information for the administrative management of pediatric hematology/oncology programs. Caution must be exercised, however, when making productivity comparisons with other subspecialties or even between pediatric hematology/oncology programs. Such comparisons should take into account the number of patient encounters, characteristics of E/M coding patterns, the use of physician extenders, as well as overall RVU production.

Current Procedural Terminology↗
PubMed1993

Current Procedural Terminology (CPT) coded services provided by nurse specialists.

In this exploratory study, a random sample of nurses from nine nursing specialties was surveyed to identify which Current Procedural Terminology (CPT) coded procedures they perform and how frequently they perform them. CPT codes are used universally to file claims for physician payment. The sample included 74 school nurses, 67 enterostomal nurses, 53 family nurse practitioners, 43 critical care nurses, 43 oncology nurses, 40 rehabilitation nurses, 39 orthopaedic nurses, 34 nephrology nurses and 25 nurse-midwives. Specific questionnaires were developed for each specialty with codes identified by expert panels. The number of CPT codes ranged from 233 for family nurse practitioners to 58 for school nurses. The mean number of coded services performed by individual respondents ranged from 79 (FNP) to 18 (school nurses); individual respondents performed 0-162 codes. Supervision by physicians was very infrequent. Charges to Medicare in 1988 for the coded services included in the survey were $22,793,427.34 (aggregate allowable charges). The study provides some documentation of the degree to which nurses perform the same services and procedures for which physicians are being paid. If policy makers are serious about reaching innovative solutions to the problems of quality, access and cost, everything must be "on the table," including the contributions of nurses.

Abstracting and Indexing↗
PubMed2006

International classification of diseases and current procedural terminology codes underestimated thrombolytic use for ischemic stroke.

BACKGROUND AND OBJECTIVE: To determine the accuracy of recently introduced International Classification of Diseases Ninth Revision (ICD-9) procedure and Current Procedural Terminology (CPT) codes designed for injection or infusion of thrombolytic agents. MATERIALS AND METHODS: We determined the accuracy of ICD-9 procedure code 99.10 and CPT codes 37201, 37202 for use of thrombolysis in ischemic stroke by comparing procedure codes of University Hospital discharge data with a concurrent prospective registry. RESULTS: Of the 369 ischemic stroke patients, 49 (13.3%) received either intravenous and/or intraarterial thrombolysis. The sensitivity and specificity for ICD-9 procedure code 99.10 was 55% and 98% and CPT procedure code 37201 and 37202 was 49% and 99%. Identification by either ICD-9 codes or CPT codes yielded a high sensitivity and specificity of 82% and 98%. CONCLUSIONS: The use of ICD-9 and CPT codes alone may underestimate the use of thrombolytics using national and regional database. Best results are achieved when a combination of ICD-9 and CPT codes are used to identify the use of thrombolytics.

Brain Ischemia↗
PubMed2006

Evaluation and management codes: from current procedural terminology through relative update commission to Center for Medicare and Medicaid Services.

BACKGROUND: Physicians should have a working knowledge of the process by which patient care codes are created and subsequently assigned values. The Society of Critical Care Medicine has representatives on the national committees that focus on code creation and definition and on assignment of relative value units. In addition, a better understanding of documentation requirements and the audit process will facilitate improved compliance and minimize liability. DISCUSSION: The authors discuss the current procedural terminology (CPT) process for defining care codes and the relative update commission (RUC) process for assigning values to those codes, with each code assigned a separate value in three separate categories. Steps for managing any concern or dispute about billing, denials, or an audit are subsequently addressed. Tenets of proper documentation are discussed, and some future developments are identified that are likely to affect critical care. CONCLUSION: Knowledge of the procedures by which care codes are defined and valued is necessary for using these codes properly, as well as for addressing needs unmet by existing codes. Preventing audits is the best approach to proper coding and billing, and documentation is key.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1995

A comparison of nursing intervention classification and current procedural terminology codes for representing nursing interventions in HIV disease.

The purpose of this study was twofold: 1) to compare the ability of terms from the nursing intervention classification and from the current procedural terminology to represent the clinical terms used by nurses and patients to describe nursing interventions during hospitalization; and 2) to identify the strengths and weaknesses of the two classification systems for representing nursing systems. More NIC than CPT codes matched the concepts in the clinical terms used by nurses and patients to describe nursing interventions demonstrating, not unexpectedly, that NIC represents a broader scope of nursing practice. The major difficulty encountered using NIC was the lack of mutual exclusiveness of the nursing activities within the interventions. CPT codes were easy to apply to the clinical terms, but were limited in scope for nursing practice. The findings of this study demonstrate the necessity of using a nursing-specific classification system for the representation of nursing interventions. This is of particular importance for databases that will be used to examine the effectiveness of healthcare interventions and for databases related to reimbursement for healthcare interventions.

Databases, Factual↗
PubMedDate not supplied

Performance of current procedural terminology codes by oncology nurses: a report to the ONS board of directors.

At the request of the ONS Board of Directors, a survey was conducted to determine the degree to which oncology nurses performed services listed in the Physicians Current Procedural Terminology manual--services for which physicians are reimbursed. Using a format modeled on a similar study of nurses in general, 100 randomly selected ONS members were asked to describe the degree to which they performed a list of 90 coded procedures compiled by four oncology nurse experts. Response rate was 43%. Respondents, who were representative of the ONS membership on all demographic variables except education, performed an average of 32 of the procedures with very little, if any, direct physician supervision. Study results reflect trends found among nurses in general and raise important questions about patterns of reimbursement and healthcare delivery.

Abstracting and Indexing↗
PubMed1998

The Current Procedural Terminology and the Medicare Resource Based Relative Value Scale in neurosurgical practice.

Changes in healthcare have made it increasingly more important for neurosurgeons to understand the economic pressures that effect their reimbursement. Two fundamental concepts that are of the greatest importance are the Current Procedural Terminology coding and the Medicare Resource Based Relative Value Scale. The impact of these two entities on neurosurgical reimbursement in analyzed in this review.

Journal Article↗