Dr. Lin was introduced to the CPT process by his friend and colleague, pediatric otolaryngologist Larry Simon, MD, a current CPT editorial panel member. “The process was of particular interest to me because several otolaryngology procedures could be reported with multiple different codes and with variation in values,” said Dr. Lin. “I learned that there were sometimes formal rulings from the AMA CPT group regarding how to report certain procedures and very explicit logic behind those rulings. However, despite those guidelines, I saw several paradoxes in the reporting of certain procedures. Any otolaryngologist in practice understands that a tympanoplasty can be a very easy 20-minute surgery or a very difficult surgery requiring more than an hour. Yet, depending on how that procedure is performed in the more facile scenario, reimbursement may counterintuitively be higher.”
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November 2021Fortunately, the CPT review process allows for extensive discussion and participation from people who choose to be involved. “The process allows practitioners, their specialty societies, coders, and payers, as well as other interested parties such as those from the industry, to participate,” noted Dr. Waguespack. “Otolaryngology has active CPT advisors from the Triological Society, the AAO-HNS, and the American Rhinologic Society, as well as representation from the American Academy of Otolaryngic Allergy and the American Academy of Facial Plastic and Reconstructive Surgery. Each of these societies is represented in the AMA house of delegates. The Triological Society and AAO-HNS advisors are highly engaged with the CPT process, and the goal is to present a balanced coding perspective across our specialty.”
From our perspective, the more we can educate people on CPT and be as transparent and accessible as possible, the better. —Laurie McGraw, senior vice president of Health Solutions at the AMA
The CPT coding system is like any complex machinery in that manipulating one part may affect the function of another. As Dr. Lin noted, when a new code is sent for RUC [an acronym for the RBRVS update committee] valuation, the whole family of codes is then opened for revaluation. Final setting of a code’s relative value is made by CMS after review of the RUC’s recommendation. “Medicare is regarded as a budget-neutral endeavor, so on the surface, when we create new codes to add to a family of existing codes, valuation is taken away from those existing codes. However, the process is much more complex than that,” Dr. Lin said.
The CPT coding system is like any complex machinery in that manipulating one part may affect the function of another. As Dr. Lin noted, when a new code is sent for RUC [an acronym for the RBRVS update committee] valuation, the whole family of codes is then opened for revaluation. Final setting of a code’s relative value is made by CMS after review of the RUC’s recommendation. “Medicare is regarded as a budget-neutral endeavor, so on the surface, when we create new codes to add to a family of existing codes, valuation is taken away from those existing codes. However, the process is much more complex than that,” Dr. Lin said.