Personalized Medicine Education and Advocacy

Thought leadership in personalized medicine

Consistent, Predictable Coding Through Disruptive Innovation

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Guest Blog
by Lauren Feldman

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Lauren Feldman

The continued explosive growth in the diagnostics market is changing the health care paradigm. Rapidly evolving technologies are producing a plethora of new clinical laboratory tests, which address critical unmet needs in health care. Specifically, advances in molecular diagnostics present tremendous opportunities to significantly enhance patient care and accelerate personalized medicine. Innovation, particularly in the diagnostics space, is a driving force behind the push for greater coding accuracy and specificity.

The Protecting Access to Medicare Act of 2014 (PAMA) mandates the creation of specific Healthcare Common Procedure Coding System (HCPCS) codes for Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs) that are cleared or approved by FDA. The existing HCPCS system is comprised of Level I codes — Current Procedural Terminology (CPT®) — maintained by the American Medical Association (AMA) and Level II codes maintained by the Centers for Medicare & Medicaid Services (CMS).

Related to CMS’ rule-making under PAMA, the CPT Editorial Panel authorized the creation of a new clinical laboratory test section in the CPT code set. The new section provides a coding infrastructure whereby a clinical laboratory or manufacturer may request a code to specifically identify its test. Through its established, transparent processes, the CPT Editorial Panel is committed to ensuring the CPT code set remains uniform, predictable, and meets the needs of a broad cross-section of stakeholders.

To that end, the CPT Editorial Panel in conjunction with AMA CPT staff are hosting open, public meetings to solicit stakeholder input on the development of processes and structures to facilitate management of this new section of codes. The first meeting is scheduled for Tuesday, December 15, 2015, from 7:00 – 9:00 p.m. CST via conference call. A subsequent meeting is scheduled for Thursday, January 14, 2016 in Washington, D.C. To drive maximum consensus, the AMA encourages all interested stakeholders to engage in the discussions to help achieve a sustainable coding infrastructure that will ensure consistent national coding across Medicare and other public and private payers.

The aforementioned meetings will help guide the CPT Editorial Panel and CPT staff in generating a formal code change proposal to be considered at the February CPT Editorial Panel meeting (Feb. 4 – 6 at the Hyatt Regency, Miami, FL). In accordance with all CPT Editorial Panel meetings, the February meeting is open to the public, and the AMA invites you to participate in the deliberation.

For the full promise of personalized medicine to be realized at the clinical level, consistent and accurate coding is essential. As we continue to navigate this complex landscape, the goal is to create a comprehensive coding solution for reporting clinical laboratory tests, thereby enabling improved patient outcomes and access to care.

For more information on CPT Editorial Panel meetings and processes, please visit http://ama-assn.org/go/cpt.


Lauren Feldman
Senior Terminology and Strategy Consultant
American Medical Association

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