The who, what and why of CPT Codes

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Renee Kinder
Renee Kinder

My introduction to CPT* came in May of 2005. A new graduate speech language pathologist, I can still see the memo clearly in my mind posted on a corkboard in the therapy gym “SLP CPT Codes.”

92610-Evaluation of oral and pharyngeal swallowing function

92526-Treatment of swallowing dysfunction and/or oral function for feeding

92507-Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual

What is more distinct in my memory, however, is the visceral response I had to this list, which I attribute to my “wh” curse.

It's a longstanding internal struggle I have with never trusting anything at face value and is surely related to having a journalist mother and years of adolescent “wh” questioning: Where are you going? What are you going to be doing? Who are you going with? Whose parents are going to be there?

I want to see some proof. Can someone show me in writing?

•   Why do I use these codes?

•   Who the heck created these? It must be Medicare right? Or ASHA?

•   What does each code mean beyond the 5-unit number on the page?

•   Who decides the value?

•   And why do my codes look so very different from the PT and OT codes?

To answer some of these questions we need to understand the structure and systems set forth by the American Medical Association, which trademarked the phrase.

Step one is to define a code, which is the responsibility of the CPT Editorial Panel.

To begin, CPT® has an established 17-member editorial panel responsible for maintaining the entire CPT code set. The panel is authorized by the AMA Board of Trustees to revise, update or modify CPT codes, descriptors, rules and guidelines.

Supporting this panel is a larger body of CPT advisors, the CPT Advisory Committee. The members of this committee are primarily physicians nominated by the national medical specialty societies represented in the AMA House of Delegates. Currently, the advisory committee is limited to national medical specialty societies seated in the AMA House of Delegates and to the AMA Health Care Professionals Advisory Committee (HCPAC), organizations representing limited-license practitioners and other allied health professionals.

Therapy codes often discussed as part of the later, the HCPAC.

The CPT® advisory committee's primary objectives are to:

•   Serve as a resource to the CPT Editorial Panel by giving advice on procedure coding and appropriate nomenclature as relevant to the member's specialty.

•   Provide documentation to staff and the CPT Editorial Panel regarding the medical appropriateness of various medical and surgical procedures under consideration for inclusion in the CPT code set.

•   Suggest revisions to the CPT code set. The advisory committee meets annually at the CPT February meeting to discuss items of mutual concern and to keep abreast of current issues in coding and nomenclature.

•   Assist in the review and further development of relevant coding issues and in the preparation of technical education material and articles pertaining to the CPT code set.

•   Promote and educate its membership on the use and benefits of the CPT code set.

An additional interesting fact is that over the course of more than five decades, no taxpayer money has been spent to develop or maintain the CPT code set.

The CPT code set is completed annually without cost to the U.S. government, and countless hours are spent to ensure that the CPT codes accurately reflect the medical care provided to patients.

And while my knowledge base grew and my initially posed questions were answered in my years as a treating therapist, it was not until I was provided the opportunity to serve as an advisor to the above CPT and RUC processes that gained a true appreciation for the coding system.

What is the RUC you ask?

Step two after a code is approved by the CPT panel is to receive a value at the RUC.

The RUC is the Relative Value Scale Update Committee (RUC) and is a group that reviews resource costs for services as described by CPT, using the 3 RBRVS components, work value, practice expense and professional liability insurance.

Payments are calculated by multiplying the combined costs of a service by a conversion factor (a monetary amount that is determined by CMS) and payments are also adjusted for geographical differences in resource costs.

Additionally, although the RUC provides recommendations, CMS makes all final decisions about what Medicare payments will be.

And while the information discussed during these meetings is held in confidence, I was pleased to see a recent Stanford scholar, David Chan, published his findings in a working paper released Feb. 26 by the National Bureau of Economic Research.

His analysis shows much of what I have observed at the RUC in that the process showed that such shared interests — and the closer connection between committee members and the specialties communicating the costs of a procedure — helped boost the overall quality of information behind committee decisions.

My personal experience in attending RUC meetings is that it is a magical, semantically perfect, dream world. One which has a distinct vernacular, where words matter, and there is a united culture aimed at getting things done the right way.

And meetings after which all my “wh” woes have finally been laid to rest.

* CPT ® = Current Procedural Terminology and is a registered trademark of the American Medical Association.

Renee Kinder, MS, CCC-SLP, RAC-CT is Director of Clinical Education for Encore Rehabilitation.  Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association's (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association's Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).

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Rehab Realities is written by Renee Kinder, MS, CCC-SLP, RAC-CT.  She currently serves as Director of Clinical Education for Encore Rehabilitation and acts as editor of Perspectives on Gerontology, a publication of the American Speech Language Hearing Association.

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