Clinicians should have a say in how medical nomenclature is created and how services are valued—after all, physicians and other qualified health care professionals are the ones directly responsible for providing patient care. The AMA created Current Procedural Terminology (CPT®) to ensure physicians are at the center of creating the uniform language for communicating complex medical services and procedures.
This process starts with the CPT Editorial Panel. The 17 experts on the AMA’s CPT Editorial Panel keep the CPT code set up to date and ensure it accurately reflects the care provided to patients. The panel receives input from doctors, medical device manufacturers, developers of diagnostic tests and advisors from more than 100 medical societies.
Anyone can attend the panel’s open meetings, which are held three times a year and typically include about 300 participants from many sectors of the medical and health care community. Similarly, anyone can submit a CPT code change application. At each meeting, applicants can answer questions about their applications before they are voted upon by the panel.
Valuing a code
Once new codes are created, or older codes are updated, the Centers for Medicare & Medicaid Services (CMS) assigns a value to each code, which determines the payments for that particular service under Medicare. To make sure physicians have a say in this process, the AMA created the Relative Value Scale Update Committee (RUC), a volunteer group of 31 physicians and health care professionals with input from 300 health care experts that represent each sector of medicine.
The RUC has open meetings three times a year, shortly after the CPT Editorial Panel meetings occur, to consider relative value codes that have been changed or added by the panel. CMS may also request the RUC to review specific codes and evaluate whether physician time, work and expenses for related services have changed over time. The RUC’s job is to consider whether the resource values associated with each code are undervalued, overvalued or spot-on.
Specialty societies survey their members and make recommendations to the RUC based on their areas of expertise. The RUC requires the most rigorous methodology for these surveys, recently increasing the minimum survey size and establishing a new centralized, online data collection process.
The two-step, tri-annual meetings of both the CPT Editorial Panel and the RUC allow physicians to provide direct input to the government, helping to meet the changing needs of medicine and speeding up the inclusion of updated medical techniques.
