Current Procedural Terminology (CPT)
CHEST Specialty Assistance Program to Industry on CPT Application Review
The American College of Chest Physician (ACCP) and the American Thoracic Society (ATS)
work together at the national level on coding and reimbursement issues through the ACCP
Practice Management Committee and the ATS Clinical Practice Committee. Major decisions are
reviewed and approved by the ACCP and ATS Board leadership. The ACCP and ATS are actively
involved in developing American Medical Association (AMA) Current Procedural Terminology
(CPT) proposals for new or revised procedure or service codes relevant to pulmonary, critical
care, and sleep medicine.
The ability to obtain new codes has evolved through early communication with industry and
provision of frequent guidance on issues pertinent to reimbursement. Often, these aspects are not
inherent in processes involved in FDA approval. Additionally, data necessary for optimizing
reimbursement for practitioners may not be considered when developing efficacy and safety
studies to support widespread clinical use of new technology. These components of the process
are aspects for which the pulmonary societies are able to confer expertise. We actively work with
sister societies, such as SCCM, AARC, and NAMDRC, on relevant issues.
To facilitate communication with industry, we have outlined required information the ACCP and
ATS need to assist in the reimbursement process. We recognize that the phase of development of
technology will vary and not accommodate the ability to provide all of this information initially.
For these projects, we are able to provide guidance as the development matures. However, all
should recognize that, ultimately, this information is needed when attempting to obtain a CPT code
and the reimbursement associated with its use. The ACCP and ATS are prepared to assist
companies desirous of proceeding along these lines at any step of their development. To prepare
our CPT advisors with the necessary defense to support new procedures, the ACCP and ATS
work through their committees, networks, and institutes to solicit input from individuals who are
disconnected from the development process, however, are considered experts in the area under
consideration. Although this critical review of the new technology may appear onerous, the CPT
and RUC process will engender this debate, and our organization recognizes this exercise
facilitates preparing the best proposal. The following reflects our guidelines for assisting with this
process. Industry should not contact the ACCP or ATS CPT and/or RUC advisors or members of the
ACCP Practice Management Committee or the ATS Clinical Practice Committee directly to
lobby for CPT proposals. Initial contact requesting this help should be directed to Diane Krier-
Morrow at dkriermorr@aol.com
To view the AMA's calendar of CPT and RUC meetings and deadlines go to: http://www.ama-assn.org/ama1/pub/upload/mm/362/calendar2007-09.pdf
Information Requested From Industry To Facilitate Pulmonary Review of CPT Code(s) and
Reimbursement
- A brief executive summary or grid of results of five US peer-reviewed literature pieces supporting the
clinical utility of the device/procedure. Peer-reviewed literature that has passed certain validation
is in Index Medicus, indexed as MEDLINE at
http://www.nlm.nih.gov/tsd/serials/lji.html. Copies or links to reprints of articles and abstracts
should accompany the submission. For less mature technologies, a descriptive narrative
explaining the technology and bulleted brief descriptions of physician work and preliminary
investigation is adequate.
- A statement regarding which authors in the quoted literature have financial ties (stock
ownership, consulting fees, research support, honorariums, hedge fund advisory position) with
the company. The presence of a financial relationship does not preclude utilization of the data for which
the investigator is responsible.
- A review of safety data regarding the device/procedure.
- A CPT application should be completed by the requestor as completely as possible (available at
www.ama-assn.org/ama/pub/category/12889.html), including all literature in support of the
application.
- The requestor should provide data regarding physician work for the procedure (preservice, intraservice, and
postservice) and practice expenses (clinical labor by staff type, disposable supplies, and
equipment) for both the facility (hospital, ASC) and nonfacility (office) settings.
- The requestor must provide the listed catalogue price for any devices and supplies involved in
performing the procedure, both in the facility and nonfacility settings.
- The requestor must provide the names and contact information of three physicians the
company feels can comfortably analyze the procedure/device and who have no financial ties or
involvement with research or hedge fund advisory relationship surrounding the company.
- Industry may forward a request to make presentations to representatives of the ACCP and ATS at
regularly scheduled quarterly committee meetings. Meetings are held in April, August, and
December each year. The number of presentations will be limited by the volume of material on
the committee agenda. Presentations are limited to a maximum of 30 minutes.
For technology/devices that are in the early stages of development, items 4 and 6 may not be
applicable.
For questions, contact:
Diane Krier-Morrow, MBA, MPH, CCS-P
American College of Chest Physicians (ACCP) and
the American Thoracic Society (ATS)
(847) 677-9464
dkriermorr@aol.com
|