What you should know about requesting New or Revised CPT Codes or Guidance on how to code for New Technology
The Physician Payment Policy Workgroup (3P), co-chaired by James Denneny III MD, and Jane Dillon MD, the Coordinators for Socioeconomic and Practice Affairs, is the senior advisory body to Academy leadership and staff on issues related to socioeconomic advocacy, regulatory activity, coding/reimbursement, and practice services/management.
The 3P group evaluates inquiries for new technology coding and requests for new Current Procedural Terminology (CPT) codes or revisions to existing CPT codes. Members of 3P, including Richard Waguespack, MD, Bradley Marple, MD, and Lawrence Simon, MD, represent otolaryngology interests on the AMA CPT Advisory Committee. Our CPT representatives advocate for otolaryngology by presenting new and revised CPT codes to the CPT Editorial Panel for inclusion in the code set used for physician billing.
When it comes to valuing CPT codes, the 3P group serves as the expert consensus panel to analyze surveys completed by Academy members and make recommendations for appropriate Relative Value Units (RVUs) to the AMA/Specialty Society Relative Value Update Committee (RUC) for otolaryngology-related codes. Some of these members (Wayne Koch MD, Charles Koopmann MD, MHSA, John Lanza MD, Jane Dillon, MD, Pete Batra MD, and Peter Manes, MD) also represent the Academy at the RUC meetings. The RUC makes recommendations on the Relative Value Units (RVUs) of new and revised physician services to the Centers for Medicare and Medicaid Services (CMS). The RUC also performs broad reviews of the Resource Based Relative Value System every five years and rolling reviews of many codes based on screens such as high utilization, frequency of codes used together, and codes not surveyed since the beginning of the RUC process over twenty years ago.
To provide a more streamlined process, consistent with approaches adopted by other specialty societies, 3P initiated development of the New Technology Pathway, a process approved by the Board in September, 2010 that the Academy has adopted and now requires for any requests for guidance on how to code for a new technology, new CPT codes for services or procedures, or revisions or revaluations of existing codes. The newly formalized process includes coordination between 3P and experts from other applicable AAO-HNS Committees (i.e., Medical Device and Drug Committee, CPT/RVU Committee, etc.) as a way to incorporate all of the resources of the Academy in the interest of the members. We are confident that the New Technology Pathway will address such requests in a manner which is clearly defined, consistent with AMA CPT and RUC guidelines, accounts for the interests and perspectives of all stakeholders while protecting against undue influence of any group or individual, encourages the collection of reliable data, and promotes efficient, fair reimbursement for our members and appropriate access to new procedures and services for our patients.
Inquiring parties, including physicians and industry representatives, should send the completed package to the Academy’s staff Jenna Kappel, Director, Health Policy at JKappel@entnet.org.
AMA Criteria for all CPT codes:
|Level of Evidence Table - LOE|
|Level||Type of Evidence (Based on AHCPR 1992)|
|Ia||Evidence obtained from at least one randomized controlled trial|
|IIa||Evidence obtained from at least one well-designed controlled study without randomization|
|IIIb||Evidence obtained from at least one other type of well-designed quasi-experimental study|
|III||Evidence obtained from well-designed non- experimental descriptive studies, such as comparative studies, correlation studies and case control studies|
|IV||Evidence obtained from case reports or case series|
|V||Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities|
Posted on November 30, 2010
Updated on October 28, 2013