My name is Michael Beebe. I am the Director of CPT Editorial and Information Services for the American Medical Association (AMA). It is my pleasure to appear today on behalf of the AMA before the Subcommittee on Standards and Security of the National Committee on Vital and Health Statistics. The AMA accepts the responsibility for updating and maintaining CPT, and is committed to working with all health care professionals to include codes for unique and clinically effective services provided to patients. I thank you for the opportunity to demonstrate our efforts to explore the inclusion of codes for alternative therapy.
At the April 10th meeting of the Subcommittee, several presentations were made by groups which demonstrated certain gaps in the nationally designated codes sets. Among the identified gaps were codes to describe the services provided by alternative therapy providers. The Subcommittee recommended that the AMA and Alternative Link, Inc. work together, through the CPT Editorial Process, to develop codes to facilitate the reporting of alternative therapy services under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). My statement will describe the CPT Editorial Process, the AMA’s view of its obligations as the maintainer of a HIPPA designated code set, and its plans for developing codes and descriptors for alternative therapy. I will also review our efforts at working with Alternative Link, Inc. in developing codes for alternative therapy services.
The CPT Editorial Process
The CPT code set is maintained by the AMA through an Editorial Panel that employs well established, publicized, and documented procedures. As the maintainer of a national code set designated by the U.S. Department of Health and Human Services under HIPAA, the AMA, through the CPT Editorial Panel, has the responsibility to work with individuals and organizations to update the CPT code set so that coding needs of all groups who send and receive health care information electronically are met. Anyone can submit a proposal for a new CPT code or for a change in an existing CPT code. The instructions and code change proposal application are available on the AMA/CPT internet site, http://www.ama-assn.org/cpt, along with a schedule of Panel meetings and deadlines.
In order for any code to be included in CPT, a well established CPT Editorial Process must be followed. By requiring all organizations and individuals to follow the same process, the AMA and the CPT Editorial Panel are able to:
For these reasons, the CPT Editorial Process is an essential component of the development of the CPT code set and can under no circumstances be bypassed or shortcut. Also, circumventing the CPT Editorial Process would lead to internal inconsistencies, structural defects and inferior descriptions . Moreover, to allow an individual or group to go around the CPT Editorial Process or to be treated differently would not be fair to others who are interested in changes to CPT. Adherence to the CPT Editorial Process is an important part of CPT’s integrity as a HIPAA designated code set, as well as a definitive characteristic of CPT codes themselves.
The CPT Editorial Panel is supported in its work by the 112 member CPT/HCPAC Advisory Committee. Committee members are nominated by the national medical specialty societies and the Health Care Professionals Advisory Committee (HCPAC). Since its establishment in 1992, the HCPAC has allowed for the participation of organizations representing limited license practitioners and allied health professionals in the CPT process. The HCPAC includes representation from the following specialty societies:
American Academy of Physician Assistants
American Chiropractic Association
American Dietetic Association
American Nurses Association
American Occupational Therapy Association
American Optometric Association
American Physical Therapy Association
American Podiatric Medical Association
American Psychological Association
American Speech-Language and Hearing Association
National Association of Social Workers
As a result of the activities of these and other organizations, the CPT work contains creative descriptions of services and procedures performed by non-physician health care professionals. The CPT code set currently contains the following codes for services that may be considered alternative therapy:
97124Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)
97140Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes
97780Acupuncture, one or more needles; without electrical stimulation
97781Acupuncture, one or more needles; with electrical stimulation
98940Chiropractic manipulative treatment (CMT); spinal, one to two regions
98941Chiropractic manipulative treatment (CMT); spinal, three to four regions
98942Chiropractic manipulative treatment (CMT); spinal, five regions
98943Chiropractic manipulative treatment (CMT); extraspinal, one or more regions
The AMA and the CPT Editorial Panel recognize that CPT’s position as a designated national HIPPA code set may require the development of additional codes to describe other services provided by alternative therapy providers. It may also be necessary to expand the membership of the HCPAC to include professional organizations representing additional alternative therapy providers. The AMA is committed to making these changes. But, any activity designed to expand or change the CPT code set must follow the CPT Editorial Process.
CPT Editorial Panel Approach to the Inclusion of Descriptions of Alternative Therapy
In response to the designation of CPT as a HIPAA code set, the AMA, through the CPT Editorial Panel, has made every effort to work with groups who have an interest in new codes. Recently, for example, the Editorial Panel established a Home Health Workgroup made up of private payors and home health professionals to assist in the evaluation and incorporation of home infusion codes proposed by the Home Infusion EDI Coalition (HIEC), who also participates on the Workgroup. Similar to Alternative Link, Inc., HIEC had developed a code set to meet the needs of the home infusion industry, but which did not conform to HIPAA requirements for a procedural code set since it was an amalgam of providers, supplies, drugs and services. Although the Workgroup is still in progress, working with HIEC has been an important learning experience for both parties, and the CPT Editorial Panel is confident that home infusion CPT codes will be developed to meet the needs of the home infusion community.
The CPT Editorial Panel has adopted a similar approach to the evaluation and development of descriptions of alternative therapy for possible inclusion in CPT. The Chair of the CPT Editorial Panel has appointed an Alternative Therapy Workgroup consisting of national organizations representing providers of alternative therapy, non-physician health care professionals from the HCPAC, members of the Editorial Panel, members of the payor community and Alternative Link, Inc.
The Workgroup has been charged with:
By bringing the relevant stakeholders together under its leadership, the Editorial Panel, can resolve issues and problems more quickly and with better results than by following a more independent code proposal process. Using a multi-disciplinary Workgroup will also allow the Panel and the Advisory Committee to have access to the most current information on alternative therapy and will serve to internally scrutinize coding proposals. One of the criteria for a CPT code is that the clinical efficacy of the service/procedure has been well established and documented. As the Alternative Therapy Workgroup begins to examine a framework for the inclusion of descriptions of alternative therapy in CPT, this requirement will need to be handled in a very deliberate and open manner.
AMA CPT has begun to assemble the membership of the Alternative Therapy Workgroup and is working on a schedule of meetings. Alternative Link, Inc. has been invited to participate in the Panel’s Workgroup, but has thus far not accepted.
Cooperative Efforts with Alternative Link, Inc.
The AMA has made serious and deliberate attempts to work with Alternative Link, Inc. Since April 10th we have had one meeting, one lengthy conference call and exchanged several letters and e-mails. The AMA has expressed our willingness to work with Alternative Link, Inc. through the CPT Editorial Process to develop code change proposals. We have invited the company to participate in the Alternative Therapy Workgroup the Panel is assembling. Although the meetings have been productive from the stand point of developing an understanding of one another’s positions, they have not produced an agreement on how to develop CPT codes for alternative therapy.
Previously the Subcommittee recommended that the AMA and Alternative Link, Inc. work together, through the CPT Process, to develop codes to facilitate the reporting of alternative therapy services under the HIPAA. The Subcommittees request was not for the AMA and Alternative Link, Inc. to explore options for incorporating Alternative Link’s codes into CPT. There is an enormous difference between creating codes for a service and importing codes for that service developed by another group or company.. This is a significant difference because the CPT Editorial Process guarantees a critical level of consistency in procedure coding, code application, and clinical decision-making as to what constitutes appropriate descriptions of health care services. These functions would be eroded by the wholesale inclusion of another group of codes. Moreover, wholesale inclusion of another group of codes would undermine the core benefit of having a rigorous editorial board maintain the integrity and uniformity of CPT.
Alternative Link, Inc. has argued that the CPT Editorial Panel, by developing codes for alternative therapies, is appropriating Alternative Link’s intellectual property without remuneration. This is simply not the case. The AMA has no intent to utilize Alternative Link, Inc. pre-existing code. Rather, we intent to create new codes that meet CPT Editorial standards and that are an integrated part of a coherent work of coding.
The CPT Editorial Process begins with the code change proposal application or in this case a Workgroup of providers. The application or Workgroup recommendations contains the ideas and concepts of physicians or other health care professionals on how to describe the service(s) they perform. Once the code proposals go through the CPT Editorial Process, the AMA, through the Panel, works to create consistent terminology, develops coding guidelines, and determines modifier usage, then the final work product is a creative expression that is copyrighted by the AMA. It is highly likely that any ideas that were submitted would be so significantly and substantially changed by the CPT Editorial Process as to make them unprotectable. Prior to review by CPT/HCPAC Advisors and the CPT Editorial Panel, ideas about a service or procedure are not the intellectual property of anyone and are not copyrightable.
Alternative Link, Inc. has developed a coding work and database for alternative therapy. This work links providers with state licensing requirements. Significantly, however, Alternative Link, Inc. is not a professional organization and does not represent any element of the alternative therapy provider community. In this sense, providers of alternative therapy services have not voiced the concern that their services will not be recognized under HIPAA and that their business needs will not be met. Rather, Alternative Link, Inc. has raised this concern. Alternative Link, Inc. may be a company that has developed a product that is jeopardized by the HIPAA transaction standards. The AMA has made a proposal to Alternative Link, Inc. to assist them with their needs under HIPAA.
Once the Alternative Therapy Workgroup has established a functional framework and alternative therapy codes have been developed by the AMA through the CPT Editorial Panel, the AMA has offered to work with Alternative Link, Inc. on the development of a crosswalk, or mapping, from CPT alternative therapy codes to alternative therapy codes that exist in the ABC coding work of Alternative Link, Inc. and visa-versa. Such a crosswalk would enable Alternative Link, Inc. to utilize its databases to link services with provider and state licensing information, thereby providing the claims processing functions that are an important part of the business need of Alternative Link, Inc. The crosswalk would also allow Alternative Link, Inc. to take advantage of the larger national claims processing market provided by linkage with CPT.
Conclusion
The AMA takes its responsibility to maintain CPT very seriously. It constantly strives to produce the most up to date, useful and intelligible code set possible. The AMA and the CPT Editorial Panel recognize that CPT’s designation as a national HIPAA code set for electronic health care imposes an obligation to be responsive to the coding needs of health care payors and providers. The AMA and the Panel accept this obligation. However, we must request that individuals and organizations who want changes to CPT be required to follow the established process. CPT may have been selected as a HIPAA designated code set due to its general acceptance, but we believe it was generally accepted due to respect for the CPT Editorial Panel, the CPT Editorial Process, and the substance of the CPT work. We look forward to working with the Committee and this subcommittee to address your concerns and answer your questions.
Thank you for the opportunity to present the views of the American Medical Association and the CPT Editorial Panel. At this time I would be pleased to respond to any questions that you might have.