Sergio Bartakian, MD, FSCAI, FAAP; Sarosh Batlivala, MD, MSCI; Dawn Gray, SCAI Staff; Gurumurthy Hiremath, MD, FACC, FSCAI;Mark H. Hoyer, MD, FSCAI; Frank Ing, MD, FACC, MSCAI
This article represents the first in a series of papers introducing the Pediatric Interventional Cardiology Coding Workgroup (PICCW) to the pediatric cardiology community, and provides updates and education regarding the process of Current Procedural Terminology (CPT®) code creation.
In 1966, the American Medical Association (AMA) first published a set of standard terms and descriptors to document medical procedures, known as CPT. Over the next 30+ years, numerous revisions took place with each progressively more detailed, in line with the increasing complexity of the health care system. In 2000, after a thorough review by the AMA, CPT became the national coding standard for reporting medical services and procedures.
TABLE 1 CPT Codes Specific to CCCHD Through Early 2016
ASD – Atrial Septal Defect, PDA – Patent Ductus Arteriosus, VSD – Ventricular Septal Defect
The CPT Editorial Panel is responsible for maintaining the CPT code set and is supported by the larger body of specialty society advisors, the CPT Advisory Committee. The members of this committee are primarily physicians nominated by the national medical specialty societies. Currently there are 156 members serving in this capacity. The importance of adequate representation on this committee cannot be overstated. The number of representatives per specialty is variable; some specialties are represented by a dozen or more members due to representation by multiple societies while others, such as the National Athletic Trainers Association and the American Massage Therapy Association have two advisors each. Unfortunately, the pediatric cardiology community never sought to be formally involved in this process until 2017 with the nomination and appointment of the author through the Society of Cardiovascular Angiography and Interventions (SCAI).
Whereas the CPT Panel oversees the process of creating new codes, it is the task of the Relative Value Scale Update Committee (RUC) to recommend a value to the Centers for Medicare and Medicaid Services (CMS). Overall, the process of creating a new code involves initial presentation by the Specialty Society Advisor to the CPT panel. At these sessions, the code is assigned a 5-digit number, and the description of the work performed is outlined. Once approved by CPT, the proposed code is surveyed among the stakeholder society members, according to stringent rules, regarding the time and intensity needed to perform the respective procedure. A society representative then presents the society’s recommended value for the code based on the RUC survey, to the RUC panel for valuation. The results of the RUC meeting and their recommended Relative Value Units (RVU) are then forwarded to CMS for formal acceptance.
To read the full article, please go to the April 2020 Issue of CCT.