An Inside Look at How the CPT Is Kept Balanced and Current

Developed and introduced by the American Medical Association (AMA) in response to the implementation of Medicare in 1966, the Current Procedural Terminology (CPT) coding system has since become the principal uniform language used by healthcare professionals and administrative personnel to describe specific medical services and procedures. To date, CPT encompasses some 10,000 codes, and the set is continually evolving to keep pace with ongoing advancements in science, technology, clinical protocols, data management, and more. Facilitating that tall order requires the complex and multifaceted system that exists today, under the watchful eye and hands-on maintenance and support of the AMA.

Although hospitals, clinics, and private medical practices across the country rely on CPT for billing reimbursement, among other things, the system itself, and the process by which it is kept balanced and current, may seem mysterious and even confusing to practitioners and their staff. Indeed, a closer look inside the workings of the CPT coding system reveals a complex world of moving parts that are synchronized enough to coordinate the reporting, supporting, advisory, and decision-making activities of hundreds of people—yet flexible enough to adapt to unanticipated emergencies, such as a global public health crisis.

Defining the Updating Process

The primary responsibility for the curation of the CPT code set lies with the CPT editorial panel (currently expanding from 17 to 22 members), appointed by the AMA board of trustees. The panel comprises an independent body of physicians who typically meet three times a year for multiple days at a time. There are 200 independent advisors to the CPT panel, also appointed by the AMA board of trustees. “This group intersects with all of the approximately 180 medical societies that have seats with the AMA’s house of delegates,” explained Laurie McGraw, senior vice president of Health Solutions at the AMA. The AMA staff supports the panel by providing information, documentation, people power, and technology support— in short, the fuel required to keep the machine running.

“From our perspective, the more we can educate people on CPT and be as transparent and accessible as possible, the better,” said McGraw. To that end, she offered a step-by-step description of the CPT process.

1. Code change requests. “Code change requests are put forth when it appears that there’s a novel innovation or procedure for which there is currently no existing code, an existing code or category of codes that needs to be modified, or a code that needs to be deleted altogether because it’s no longer applicable,” she said.