CPT coding changes: another progeny of Medicare reimbursement – Current Procedural Terminology

CPT coding changes: another progeny of Medicare reimbursement – Current Procedural Terminology – Editorial

Morris B. Mellion

The implementation of Medicare physician reimbursement reform brings dramatic revisions in management and evaluation service codes (visit codes.) The codes are used on claims that generate about 35 percent of payments to physicians under the Medicare Part B program.

The new coding system, which can be found in the American Medical Association’s CPT 1992: Physicians’ Current Procedural Terminology coding manual, is the progeny of Medicare physician payment reform legislation enacted by Congress in 1989. The reform legislation mandated two significant changes in the Medicare payment system: (1) the elimination of specialty payment differentials and (2) the creation of a resource-based relative value scale (RBRVS) for Medicare payment to physicians. Sweeping changes were necessary in the coding of physicians’ services to make these payment reforms work. Physicians who fail to use the new codes appropriately will very likely receive less reimbursement than they should under the new system.

In response to Medicare’s decision to push ahead with rapid implementation of a new and complex set of visit codes by January 1, 1992, the AAFP launched in November 1991 an informational campaign to raise members’ awareness of the new codes. The campaign has included articles in the November and December issues of the AAFP Reporter and AFP’s November “Newsletter.” to speed the distribution of the new CPT manual to physicians, the AAFP Practice Support Initiative distributed thousands of order forms for the manual, which is available in book form and computer software. In addition, AAFP’s 71,000 members received a special informational letter from in November, accompanied by a pocket guide describing the new office visit codes.

Changes in the coding system include elimination of visit codes 90000 to 90699 and 90750 to 90764. The codes are replaced by an entirely new section on evaluation and management services. Completely new codes have been assigned to office visits, hospital inpatient services and consultations, emergency department services, nursing facility services and home services. Accurate and complete documentation of the new codes is essential.

The new system does more than replace one set of numbers with another–there is no direct comparison between the new and old codes. The “Overview of New CPT Codes,” attached to the November 1991 AAFP President’s letter, is a relatively brief and lucid set of instructions on how to use the new codes.

As designed by the AMA’s CPT Editorial, Panel, the new coding system requires that physicians exercise far greater judgment in determining the level of medical service for each component of their work. The article on CPT coding by Drs. Zuber and Henley [1] provides an overview of the changes. Dr. Henley, an AAFP Board member, serves on the AMA Current Procedural Terminology Editorial Panel.

While the application of the previous coding system was fraught with wide variances, the new system promises a more precise and, ultimately, more equitable method for physicians to code evaluation and management services. With a truly dedicated effort, physicians and their staffs can quickly learn the proper use of the new codes and, in doing so, play a crucial role in assisting the effort to bring greater equity to physician reimbursement for services to Medicare patients. If private payers adopt the Medicare standard, as they have traditionally done, these changes will eventually affect the practices of all physicians.


[1] Zuber TJ, Henley DE. A guide to the new office evaluation and management of codes for 1992. Am Fam Physician 1992; 45:703-8.

COPYRIGHT 1992 American Academy of Family Physicians

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