New codes are coming for the Current Procedural Terminology (CPT) code set to bring more specificity to coding for an expanding range of telehealth services.
The American Medical Association, which develops CPT codes, generally does so in reaction to proposals from industry stakeholders who make a case for new codes. But as telehealth quickly expands to support accountable and value-based care, AMA is moving ahead on telehealth codes, saying it can’t wait for proposals to be submitted.
For instance, solutions are needed now for reporting non-telehealth services when using remote telehealth technology, and new evaluation and management services codes may be necessary “based on emerging new patterns for sites of services,” a spokesperson for the association said.
AMA is forming a diverse workgroup, comprising more than 50 experts, which held its first meeting on October 8.
“A more proactive approach is necessary to keep pace with change,” the AMA explains in a statement. “The workgroup was created to accelerate the editorial process for new codes or changes to existing codes. Essentially, the workgroup acts as a conduit for telehealth coding proposals to the CPT Editorial Board. They can propose codes and review submissions that also come from stakeholders.”
While AMA is accelerating the coding development process with a workgroup, it still also will rely on input from other stakeholders throughout the process, says workgroup member Barbara Levy, M.D., vice president for health policy at the American College of Obstetricians and Gynecologists.
“We hope to create a structure that everyone can plug into,” Levy says. For instance, there is no uniformity in payer reimbursement of a variety of telehealth-supported virtual visits; insurers simply adjudicate these claims via their existing processes.
The timeline for the initiative will be ongoing, although the expectation is to have easier items on the agenda ready by the February meeting of the AMA CPT editorial panel, so members can vote on an initial set of proposals for new codes, says Frank Dubeck, M.D., a geriatric medicine specialist in Utica, N.Y., and chief medical officer for medical policy at Excellus BlueCross BlueShield. Any proposals that may be approved would be in the CPT book in 2018.
With activity in the industry to remove regulatory roadblocks to telehealth, including state licensure policies, HIPAA and payer coverage, the time is now to start work on identifying needs for new CPT codes, Levy notes.
However, to be ready for initial action in February, proposals have to be submitted by early November. “This is an ongoing project that AMA CPT is taking on, similar to our care coordination and transition management codes, to capture the future of how healthcare will be delivered,” Levy says.
The workgroup is still looking for additional members. Interested individuals can submit a written statement with their rationale for participating and a brief description of their expertise to firstname.lastname@example.org.
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