To maximize proper payment for the medical services your clinic, hospital or health system provides, it is critical that your health IT vendor be up-to-date in licensing the Current Procedural Terminology® (CPT) data that is essential to the task.
A license from the AMA is required for health care delivery organizations and health IT vendors who use CPT in their products, such as electronic health records or practice-management systems, to have compliant coding systems. The CPT data file is updated annually and a new license is required for each year’s new file.
It’s wise to check with your IT vendor to see whether your coding system is compliant with the latest actions of the CPT Editorial Panel. Recent years have seen newly released codes in these categories:
- CPT Category I vaccine codes
- CPT Category II codes
- CPT Category III codes
- Molecular Pathology Tier 2 codes
- Multianalyte Assays with Algorithmic Analyses codes
- Proprietary Laboratory Analyses codes
Beyond that, the questions to ask your IT vendor depend on how CPT is incorporated into the system you use.
Solutions with CPT included. If you use a system in which CPT is already embedded, then your vendor or IT department should apply to become an authorized CPT Distributor. The procedure is straightforward and the AMA encourages easy access to CPT data.
Solutions without CPT. If you work in a practice setting in which you, as users of the product, input or upload coding data into the product, then all the users of the product require a CPT license.
User proxy model. Sometimes, it gets complicated to count who should be included as a “user” for CPT licensing purposes. To address that, the AMA introduced the User Proxy Model, a way to approximate users based on metrics such as staffed beds to determine the number of users of EHRs, patient billing systems and practice-management systems. If this sounds like the situation in your setting, this may be an alternative to investigate to keep CPT licensing up-to-date.
The AMA has a number of coding resources to help you accurately bill procedures and services with CPT and Healthcare Common Procedure Coding System codes.