Moving Medicine

Why CPT and its evolution in health care crises matters, Part II with Mark Synovec, MD and Chris Jagmin, MD 

Dec 21, 2022

In part two of this series on Moving Medicine, Chris Jagmin, MD, vice-chair of the CPT® Editorial Panel and chair of the CPT Assistant Editorial Board along with Mark Synovec, MD, chair of the CPT Editorial Panel during the COVID-19 pandemic, continue their conversation about the influence of CPT in the health care system. 

Speakers

  • Mark Synovec, MD, chair, CPT Editorial Panel
  • Chris Jagmin, MD, vice chair, CPT Editorial Panel; chair, CPT Assistant Editorial board
  • Leslie Prellwitz, director, CPT Content Management & Development, AMA

Host

  • Todd Unger, chief experience officer, American Medical Association

Listen to the episode on the go on Apple Podcasts, Spotify or anywhere podcasts are available.

Unger: Today’s episode of Moving Medicine, a podcast by the American Medical Association, picks up our conversation with Dr. Chris Jagmin and Dr. Mark Synovec, accompanied by AMA’s Leslie Prellwitz. They continue to discuss the evolution of CPT and its importance, especially in health care crises.

Dr. Mark Synovec is chair of the CPT Editorial Panel and Dr. Chris Jagmin is vice-chair of the CPT Editorial Panel as well as chair of the CPT Assistant Editorial Board. 

Here’s Leslie Prellwitz.

Prellwitz: So, as we're talking about bringing people along to new processes and new ways of doing things, one of the things that's always on our mind is that there's always newly minted physicians, folks who are just starting to learn about CPT or perhaps they don't know a whole lot about CPT because their billing happens in a building far, far away, that they never really have to interact with it very much. But for those who are just starting to learn, you two obviously have many great years of experience and tales to tell and inputs that you really can't have if you're not in the process, but Dr. Jagmin, I'd like to hear what would be your advice to physicians, other qualified health care professionals, and maybe they're just starting to learn about CPT. What would be your advice to them?

Dr. Jagmin: I think they need to view CPT as something more than just a billing mechanism. The codes and the diagnosis codes associated with them actually communicate a lot more information about public health, about longitudinal care, about chronic care. So, even if you no longer are dependent upon your own bookkeeping or your own collection of payments, you still need to learn the lingo because in this increasingly digital world, your medical record is in some ways defined by those CPT codes that you may or may not understand. So, certainly, you need to learn what you do in your field, and if you want to communicate well with specialists in other fields, you may need to understand their viewpoint from CPT coding also.

Prellwitz: So, in terms of that, one of the interesting parts is not only learning about CPT, but having the time to learn about CPT. Dr. Synovec, recently, there's been quite a bit circulating in the media about physician burnout. Time pressures are real and valid for everyone. I haven't found anyone for whom that doesn't apply. I'd be curious to know your advice that you would give to actively practicing physicians who find the prospect of being a part of the CPT process interesting, but simply feel there aren't enough hours in the day to get involved. What would you respond to that question?

Dr. Synovec: Well, yes, there are stressors out there. I think we've all become different through COVID, for example. It seems like we still have the pressures of COVID, but we have all those other pressures we had before, and they're just kind of mounting, and the world just seems to change faster and faster, so I certainly can comprehend that. For me, I'm a physician first and a pathologist second, and this allows me to stay whole as a physician, and I can still use my professional energy in a way that's not just so refined to looking through my microscope, for example. So, I find it, even though it's work, it's enjoyable work. It's kind of my fun part of my job, and the diversity really helps me with that. So, I totally think that it takes time, yes, but as we all learn through the computer, you just get more efficient through that process. And this is the same thing, and I certainly would encourage younger physicians that are interested in this to talk to their specialty societies.

Typically, when you start, it's not like you're going to have to commit to being a panel member and giving up entire days. A lot of that can be done virtually, and they just want your opinion on what you do best. There's a long learning curve in CPT. There's a lot of nuances. The power of the semicolon is, for example, what we do, which I'm not going to go into the details here, but over time, things that become or originally were so foreign, they just become so natural. So, I wouldn't get too scared of it on the front end. Stick your toe in the water. See if it's something that works for you, and hey, you might be sitting here as the panel chair or panel chair elect. So, we'll see how that goes.

Prellwitz: All right. Well, you raised an interesting point, Dr. Synovec, in terms of physicians, and starting to hear about their world, hear what they do in their practice. So much of CPT is about it's a language and it's really only as strong as the composite of the voices that go into that language in creating it. There's been a lot of talk in the news. Nothing particularly new, just time pressures around issues with health equity and how that's impacted care. Dr. Jagmin, I'd like to hear your perspective on the relationship between CPT and the goal of advancing health equity, about the connection that you see there.

Dr. Jagmin: Well, the fascinating thing about that particular question is what happened during the PHE. When all of a sudden behavioral health became essentially a virtual service, with the curation and creation of appropriate telemedicine, CPT codes and modifiers to report the same. That no doubt has impacted health equity in my mind because we've been able to serve people who didn't live near a hospital, who weren't in an advanced community, but yes, had a cell phone, yes, had some audio-visual capability. You'll get different flavors of that from people, but I think by and large, that has been a huge boon to behavioral health equity.

Prellwitz: Fantastic. It sounds like from what we've seen of some of the data, the advance of telehealth is one that may have reached its height at a certain point earlier in the pandemic but it's certainly something that's not going to go away. The door really has been opened, it's hard to close it entirely. So, excellent observation there.

Dr. Synovec, I'd have a similar question for you. We're talking about forecasting developments in CPT, what we've seen happen with telehealth, but in your world, looking at CPT developments, the future of medicine, in your time as chair, what are some of the things that you might expect or you might even hope for going forward?

Dr. Synovec: Clearly one of the areas that we've spent a lot of time recently is in digital medicine as it relates to both telehealth, but also in artificial or augmented intelligence or machine learning. I think that's going to be a really interesting area. I can tell you that we're struggling with that somewhat, but it's not really a unique struggle because by definition, CPT is on the cutting edge. We need to make sure we have a foundation of the language that people will use and then, this is just another example of that.

We're forging ahead, trying to come up with the definitions, and I guess that's partly one of the areas that's so fun for CPT because you take this humble country pathologist from Topeka, Kansas, and I can be sitting in the room and we're having these debates on what words should we use when we try to capture these services, knowing that we don't really know right now because we're having trouble predicting what's going to happen tomorrow, let alone 10 years from now. But whatever we're working on now is foundational, and if we get it right or get it as close to being right as we think we can, it'll help us get to that end point. So, I think that's probably the most exciting area.

Then, molecular diagnostics is another area. We've obviously been working with that for over a decade now. I think back in 2009, when we first heard about this, we thought by this time, "Hey, everyone will get their whole exome. It'll be done and we won't have to deal with anything." Boy, that hasn't happened. It's just gotten more complex, not less complex with that, with different technologies and different platforms. So, we'll have to see how that goes.

Prellwitz: Dr. Jagmin, I will ask you the same question. As you take a look in your crystal ball that is CPT, your wishes, thoughts, predictions on what you see down the pike?

Dr. Jagmin: Well, I think Mark's right in digital medicine and electro-diagnostics continue to be evolving fields. I'm also interested in the notion of team care. As we go more and more into complex organizations and teams of providers, not just physicians, practicing medicine with the best interests of the member at heart, which maybe you're seeing them at home. You're seeing them in the mall. You're seeing them at your local pharmacy or wherever, and how you report those services, who reports those services, who for instance, is a qualified health care professional in CPT language. Those are going to be some fascinating evolutionary debates as we go forward.

Prellwitz: Fantastic. I would definitely agree with the evolution of medicine and how and where that care is provided and seeing CPT work with those evolving paradigms as they come through is really going to be fascinating. Well, it was a pleasure speaking with both of you today. Thank you so much. This has been a wonderful conversation. I'm glad you were both able to be with us. I'm Leslie Prellwitz and thank you for joining us on Moving Medicine.

Unger: You can subscribe to Moving Medicine and other great AMA podcasts anywhere you listen to yours or visit ama-assn.org/podcasts. Thanks for listening.


Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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