What You Should Know about Requesting New or Revised CPT Codes, Guidance on How to Code for New Technology
The Physician Payment Policy Workgroup (3P), co-chaired by Richard W. Waguespack, MD, coordinator for Socioeconomic Affairs and Michael Setzen, MD, coordinator for 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 works tirelessly to evaluate inquiries for new technology coding and requests for new Current Procedural Terminology (CPT) codes or revisions to existing CPT codes. Members of 3P, including Dr. Waguespack, Bradley M. Marple, MD, and Brendan M. Stack, 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, 3P 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 M. Koch, MD; John Lanza, MD; Charles F. Koopmann, MD, MHSA; Bill Moran, MD; and Jane Dillon, MD) also represent the Academy at the RUC meetings. The RUC makes recommendations on the 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 more than 20 years ago. To provide a more streamlined process consistent with approaches adopted by other specialty societies, 3P initiated development of the New Technology Pathway. The process was approved by the Board in September 2010 and the Academy adopted and now requires it be used 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 (e.g., Medical Devices and Drugs Committee, CPT and Relative Value Committee, etc.) as a way to incorporate all of the Academy’s resources in the interest of its members. Since the New Technology Pathway process has been formalized, we have been able to be confident in addressing such requests in a manner that is clearly defined, is 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. The New Technology Pathway starts by completing the New or Revised CPT Code Application, an internal Academy document, elements of which are illustrated below. Inquiring parties, including physicians and industry representatives, should email the completed package to the Academy’s staff at JKappel@entnet.org. Applications are available at http://www.entnet.org/Practice/Applying-for-CPT-codes-and-Obtaining-RVU.cfm.
The Physician Payment Policy Workgroup (3P), co-chaired by Richard W. Waguespack, MD, coordinator for Socioeconomic Affairs and Michael Setzen, MD, coordinator for 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 works tirelessly to evaluate inquiries for new technology coding and requests for new Current Procedural Terminology (CPT) codes or revisions to existing CPT codes. Members of 3P, including Dr. Waguespack, Bradley M. Marple, MD, and Brendan M. Stack, 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, 3P 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 M. Koch, MD; John Lanza, MD; Charles F. Koopmann, MD, MHSA; Bill Moran, MD; and Jane Dillon, MD) also represent the Academy at the RUC meetings. The RUC makes recommendations on the 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 more than 20 years ago.
To provide a more streamlined process consistent with approaches adopted by other specialty societies, 3P initiated development of the New Technology Pathway. The process was approved by the Board in September 2010 and the Academy adopted and now requires it be used 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 (e.g., Medical Devices and Drugs Committee, CPT and Relative Value Committee, etc.) as a way to incorporate all of the Academy’s resources in the interest of its members. Since the New Technology Pathway process has been formalized, we have been able to be confident in addressing such requests in a manner that is clearly defined, is 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.
The New Technology Pathway starts by completing the New or Revised CPT Code Application, an internal Academy document, elements of which are illustrated below. Inquiring parties, including physicians and industry representatives, should email the completed package to the Academy’s staff at JKappel@entnet.org. Applications are available at http://www.entnet.org/Practice/Applying-for-CPT-codes-and-Obtaining-RVU.cfm.
