Part B Insider (Multispecialty) Coding Alert

Published on Wed Dec 17, 2003 PDF

AMA reconsiders 'clinical examples'

Evaluation and management codes may not move from guidelines to examples after all.
 
At the interim meeting of the American Medical Association's House of Delegates Dec. 6 through 9 in Honolulu, the AMA considered a resolution that aimed to put the brakes on changes to code descriptors for E/M codes.
 
The AMA had recommended replacing the 1995 and 1997 guidelines for coding E/M visits with "clinical examples" that would allow physicians to set an E/M level based on their narrative descriptions (see PBI, Vol. 4, No. 25, p. 163). Eleven specialty societies had each submitted examples of narrative descriptions that physicians should be able to use to set E/M levels.
 
But a number of specialty societies objected to the new plan, and sponsored Resolution 709 calling on the AMA CPT Editorial Panel to refrain from implementing new or significantly revised E/M code descriptors and clinical examples. The resolution would force the AMA to seek input from state medical associations, specialty societies, and physicians.
 
The AMA would have to assess further whether those suggested changes will be easier and more affordable to use and whether doctors will be able to implement those changes. And it would have to obtain assurance in writing from the Centers for Medicare and Medicaid Services that it would accept those new E/M code descriptors, plus CMS' explanation of how it would perform audits and reviews based on the revised code descriptors.
 
The delegates discussed the resolution during an open hearing, according to an AMA spokesman. Several co-sponsors of the resolution testified that their intent wasn't to hinder the development of new E/M code descriptors but to validate the descriptors before they appeared in the CPT code book.
 
But representatives of the E/M Workgroup testified that they'd already accomplished many of the actions the resolution called for and that the new descriptors were only the beginning of the process. They were just carrying out previous decisions of the House of Delegates, they insisted.
 
The delegates voted at last to refer the issue to the Board of Trustees for further study.