Magazine article Clinical Psychiatry News

Should the Centers for Medicare and Medicaid Services Scrap the CPT? (Pro & Con)

Magazine article Clinical Psychiatry News

Should the Centers for Medicare and Medicaid Services Scrap the CPT? (Pro & Con)

Article excerpt

YES

In July, Senate Minority Leader Trent Lott wrote to Health and Human Services Secretary Tommy G. Thompson asking him to consider abandoning the CPT coding system. In his letter, Sen. Lott (R-Miss.) noted that the American Medical Association had in effect been given a "statutory monopoly" by the Centers for Medicare and Medicaid Services and had misused its exclusive copyright of CPT to prevent consumers from comparison shopping for physicians. These criticisms are valid and long overdue.

But before one throws something away, we usually ask, what would we do without it? How about asking first: "What did we do without it?"

When I bought my practice, there were some insurance forms and a thermal copier. To bill the patient, the staff copied the billing card. To help the patient file their insurance claim (if any), the doctor had some forms for an itemized statement that the patient could attach to the claim.

The charge was determined by the doctor; the reimbursement, by the insurance company The patient got the check, either before or after paying the doctor.

What do we get from the CPT codes? The AMA gets a reported $71 million per year in revenue. Unlike legal codes, the CPT codes change constantly. And, each revision brings the AMA more money.

Worse, the AMA has a massive conflict of interest. Should they advocate aggressively for doctors, irritate CMS, putting their lucrative contract at risk? It's likely worth more than the AMA's annual dues revenue, now less than $58 million.

What do doctors and patients get? Ever-rising costs-and the destruction of the art and science of medicine. It may take less time to find a breakthrough in medicine than for the AMA to create a code for it so that insurance will cover it.

Dr. Jane Orient is executive director of the Association Physicians and Surgeons and practices internal medicine in Tucson, Ariz. …

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