How the CPT code set can be used to help advance health equity

Andis Robeznieks , Senior News Writer

Current Procedural Terminology (CPT®) codes provide a uniform nomenclature for coding medical procedures and services that are critical to the communication between multiple stakeholders about the care patients receive. They can also be used to promote health equity.

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CPT is “not just a methodology for getting paid,” said Christopher Jagmin, MD, vice chair of the AMA CPT Editorial Panel and Aetna’s vice president of clinical policy, noting that “there is a great interest now in diversity and equity in how we deliver health care services to patients in this country and we need to recognize that in the development of our code set.”

Dr. Jagmin, an AMA member, spoke during a panel discussion on understanding the CPT code set and its place in medicine. He pointed out that the CPT-development process is led and driven by physicians who have accepted the challenge to curate and maintain the code set in a rapidly changing environment.

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Helping the Editorial Panel navigate this ever-shifting landscape is Kenyetta Jackson, MPH, director of health equity in the AMA Health Solutions business unit and leader of health equity-informed initiatives on CPT development.

“The AMA over the past several years has taken steps to make sure that health equity has become a very important part of us pursuing our mission,” Jackson said.

This includes the AMA’s strategic plan to embed racial justice and advance health equity, which calls for embedding equity in practice, process, action and innovation, and ensuring equity in access to innovation for populations and communities that, historically, have not shared in the benefits of new health care technology and procedures.

“Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential, and that no one should be disadvantaged from achieving this potential,” Jackson said.

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To this end, CPT is part of a data-driven effort to address social determinants of health (SDOH) and to identify inequity in population health. She added that, as physicians consider spending more time discussing and coordinating care to address social determinants of health, we would also like for nomenclature and coding to embed pathways for coding and payment for these services.

Health equity has come to represent a convergence of natural sciences, data science and statistics, and some of the social sciences, Jackson said.

“Data continues to reveal those disparate outcomes and chronic conditions across distinct and overlapping or intersecting demographic characteristics,” Jackson said.

Jackson noted three examples where data helped identify inequity in innovation:

  • Black, Brown, and older patients are less likely to use patient portals to communicate with their physicians.
  • Few mobile digital health applications address health crisis management or the management of chronic conditions for the patients who could most benefit from their use.
  • Patients enrolled in Medicaid, who are economically or socially marginalized, or who live in rural areas do not use live video telehealth communication as widely as other patients.

Another necessary step to promote health equity in general would be to enhance the diversity of the health care workforce and, specifically, to panels developing the CPT code set and educational programing.