CPT Suggestion Gets Cool Reception

Edition: October 2001 - Vol 9 Number 10
Article#: 1069
Author: Repertoire

A suggestion to replace CPT codes in Medicare and Medicaid with another coding system appears to be receiving little support in the industry, according to a report in a recent issue of American Medical News. The suggestion was made in a letter to the Centers for Medicare and Medicaid Services (CMS) by Senator Minority Leader Trent Lott (R-MS).

Lott questioned whether a proprietary system (the American Medical Association owns the CPT copyright) should be used for publicly funded health care programs. He called the system anticompetitive. The AMA provides CPT codes free to Medicare and its contractors, but charges a fee when the codes are used for commercial applications, according to AM News.

One alternative suggested by Lott is the new update of the ICD-9 coding system used to track inpatient procedures. That version, ICD-10-PCS, has been pilot-tested and has prompted calls to use it for outpatient care as well. But even proponents of such a change admit it would be years before a transition could be made.

Jean Harris, regulatory and coding specialist at the American College of Surgeons and a former CMS employee, was quoted as saying that implementing a new system would wreak havoc, and that it would cause health professionals to lose the ability to compare new data against historical trends.

CPT origins

CPT codes refer to the Current Procedural Terminology, a listing of terms and codes for reporting medical services and procedures. It is said to be the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT is also used for administrative management purposes such as claims processing and developing guidelines for medical care review.

According to the American Medical Association, the first edition of the CPT Code was published by the AMA in 1966. Four years later, the association presented an expanded work of terms and codes to designate diagnostic and therapeutic procedures in surgery, medicine, and the specialties. At that time, 5-digit coding was introduced, replacing the former 4-digit classification. Another significant change was a listing of procedures relating to internal medicine. In the mid- to late 1970s, the third and fourth editions of the code were introduced. The fourth edition, published in 1977, represented significant updates in medical technology, and a procedure of periodic updating was introduced.

In 1983, the code was adopted as part of the Common Procedure Coding System (HCPCS) of the Health Care Financing Administration (now CMS). With this adoption, HCFA mandated the use of HCPCS to report services for Part B of the Medicare Program. In October 1986, HCFA also required State Medicaid agencies to use HCPCS in the Medicaid Management Information System. In July 1987, as part of the Omnibus Budget Reconciliation Act, HCFA mandated the use of CPT for reporting outpatient hospital surgical procedures. Today, in addition to use in federal programs (Medicare and Medicaid), CPT is used extensively throughout the United States.