The current systems of coding diseases and procedures have changed little in the past two decades. The basis for the International Classification of Diseases (ICD) dates back to 1853; however, the current 9th Clinical Modification has been used since 1975. Similarly, Current Procedural Terminology (CPT) was developed in 1966, whereas the current 4th year version was published in 1977.
Limitations of these methods have prompted various efforts to modify the systems to reflect the many technological advances that have recently improved medical care. Following is a description of some of the anticipated changes in coding methods that will be introduced over the next few years.
Changes to Coding Systems
Recently, there also have been efforts to improve the specificity of surgical coding to account for the instances in which procedures cannot be adequately summarized by current coding descriptors. A goal of the CPT Editorial Panel is to improve the “granularity” of current, as well as future codes.
More discrete changes in both evaluation and management (E&M) codes (describing office visits, consultations, etc.) and procedural codes are anticipated in the next few years as well. The American Medical Association (AMA) has submitted a modified version of the E&M codes to the Health Care Finance Administration (HCFA) in order to simplify their application.
In the new version, several categories have been combined to simplify the “grids” in the history and medical decision making components. Documentation requirements may be reduced to improve the flexibility of a system criticized for not reflecting typical physician practice; and the examination component has been expanded to include additional “single systems” such as the spinal examination. In addition, examination items can be chosen from any system exam in an “a la carte” manner to satisfy examination documentation requirements for the various levels of service.
Despite unified efforts to resist a “bulleted” system for documenting physician work by the AMA, AANS, CNS, and other specialty societies, HCFA insisted upon maintaining such a methodology, but offered to work with the AMA in simplifying the method of accounting for the work. The current recommendation of the AMA to HCFA can be examined on their Web site (www.ama-assn.org) and may be implemented next year.
Coding for Neurosurgical Procedures
Additional changes are anticipated in neurosurgical procedure codes during the next two years. A multidisciplinary effort among the AANS, CNS, North American Spine Society, American Academy of Physical Medicine and Rehabilitation, American Academy of Pain Medicine, American Society of Neuroradiology (ASNR), American Society of Anesthesiologists and the American College of Radiology has resulted in a revision of spinal injection codes to simplify their usage. A multidisciplinary work group has also been organized to improve the spine codes when multiple surgeons perform various components of a spinal procedure (e.g., approach, decompression, and arthrodesis).
In addition, a new anterior odontoid screw fixation code has been submitted along with modification of several existing spine codes to account for far lateral, endoscopic and laser discectomies. Introductory paragraphs defining terms including “segmental” and “level” have been included to help physicians understand the components included in various spine codes. Many thanks should be shared with Samuel Hassenbusch, MD, for coordinating and advancing these significant changes.
Lastly, changes have been made to account for technological advances in the field of deep brain stimulation with the collaborative efforts of the AANS, CNS, ASNR, American Academy of Otolaryngology-Head and Neck Surgery, and the American Academy of Neurology. Modifications of an existing code may allow comprehensive accounting of computerized navigational systems for intracranial, extracranial and spinal procedures.
HCFA’s Plans for a New Coding System
HCFA has concurrently contracted with 3M Corporation to develop a new procedural coding system. Their goal is to develop a highly granular coding system that accounts for more discrete components of procedures currently identified in CPT. There are significant concerns about accurately valuing procedures in this new system. When implemented, physicians, hospitals and payers would incur a substantial cost in changing software to account for any completely new coding system.
Recognizing this, it is imperative that all physicians maintain correspondence with their CPT representatives to ensure a flexible and evolving system that properly reflects our efforts in providing quality medical care.