ISASS and Other Medical Stakeholders Submit Letter Supporting Use of CPT for Physician Claims

On July 30, 2021, ISASS, the American Medical Association (AMA), and other stakeholder organizations submitted a letter to the National Center on Vital Health Statistics (NCVHS) regarding a multi-phased effort to review clinical and administrative standards and terminologies. For phase one, NCVHS released a request for comment, due July 30^th. In August, NCVHS held a series of listening sessions, and the AMA was invited to participate.

On a related note, the Office of the National Coordinator for Health Information Technology held several meetings that resulted in recommendations to align administrative and clinical standards. Alignment included modifying the “upstream coding of information.” Rather than continuing to use a streamlined and trusted set of codes, alignment would require physicians to change how they document and describe medical information. Such a change would disrupt clinical workflow, impact physician payment, and upend payer/provider exchange—causing significant administrative burden. Third-party billing is already complex, lacking uniform billing rules and requirements. Additional disruption to this process is untenable. Furthermore, eliminating evidence-based code sets curated by clinical experts would erode decades of trust in the clinical concepts, procedures, and services that are core to physician and payer billing operations.

The letter emphasizes that the current procedural terminology (CPT) code set is a foundational element for describing medical services and procedures and is universally trusted by the health care system. CPT codes are evidence-based, timely, and reflect current clinical practice to provide a common language for medical services and procedures. The CPT code set not only enables the effective transfer of vital clinical data, but it also facilitates the exchange of administrative claims processing information. Furthermore, CPT codes are well understood and tightly integrated within physician workflows. The CPT Editorial Panel and the CPT code set is unique in that procedure code development is directly informed by a broad-spectrum of medical and clinical experts.

To read the letter, see the attached PDF.