Part B Insider (Multispecialty) Coding Alert

Published on Mon Oct 06, 2003 PDF

Association plans 11 questionnaires for specialties

The American Medical Association has made recommendations for changes to the code descriptors for evaluation and management codes.
 
The plan revolves around developing clinical examples to help physicians implement the codes and reviewers examine them, AMA officials say.
 
Eleven different specialty societies have submitted 30 different examples each for E/M coding , the officials add. The 30 examples include a narrative description of the patient's condition, which the physician ought to be able to use to determine a level of E/M code.
 
Once these are on the Web, members of each specialty will be able to sign on to a protected area on the AMA site and surveys using the 30 descriptions for their specialties. The results of those surveys will show whether the physicians and coders can use the descriptions on the site to select the appropriate E/M code.
 
This "intraspecialty validity test" will show whether physicians of the same specialty can use the clinical examples provided by their specialty to code correctly, officials say. When the physicians see an example that's meant to illustrate 99213 (Office or other outpatient visit ...), the test will show whether they actually assign 99214 or 99215 instead. The descriptors won't be grouped or organized by coding level. Instead they'll be in a random order.
 
It's all aimed at replacing the points system for determining E/M levels that has been in place since the 1995 and 1997 E/M coding guidelines approved by the AMA and the Centers for Medicare & Medicaid Services. The AMA wants to come up with a system of narrative descriptions for E/M coding that's verifiable and objective, so reviewers can use it.
 
After the intraspecialty validity test, the AMA will work with carrier medical directors and their review staffs on a similar test. If the carrier staff can use the system, the AMA may move forward with new E/M guidelines.
 
The 11 specialties involved in the test include the American College of Physicians, the American Association of Family Physicians, plus cardiologists, general surgeons, urologists and neurologists.