Court OKs collaboration on CPT codes

A company that had a CPT code request for a product denied maintains the process amounts to conspiracy.

By Amy Lynn Sorrel, AMNews staff. Sept. 3, 2007.

Organized medicine scored a legal victory in a decision physicians say upholds the CPT coding process and protects medical societies' role in it.

The U.S. District Court for the Northern District of Georgia tossed out antitrust claims that the American Medical Association and the American Urological Assn. conspired to deny a category I CPT code for Neotonus Inc.'s patented device to treat female urinary incontinence.

Neotonus alleged in a 2004 lawsuit that the AUA influenced the AMA CPT Editorial Panel -- which reviews, sets and modifies CPT codes --so its therapy would not replace more profitable procedures already in use. Neotonus claimed that the panel's denial cost the company $20 million.

But the court found ample evidence that the AMA panel -- composed of volunteer physicians -- thoroughly and independently researched Neotonus' technology and related studies before concluding there was not enough peer-reviewed research to show the treatment was effective. That requirement, among others, is necessary for a category I CPT code, used to describe services widely performed by doctors.

"This lawsuit appears to be an attempt on the part of Neotonus to have a federal court second-guess the medical expertise and opinions of the 17 Editorial Panel members and numerous medical specialty societies and payers," the August opinion states.

Physicians praised the ruling, saying it preserves a system that accurately reflects the effective care doctors provide to their patients.