Doctors and healthcare workers use special codes (CPT codes) to describe their services. These codes help streamline billing processes and increase accuracy, making them a primary language used in the medical industry.
To ensure healthcare reflects cutting-edge advancements, the CPT Editorial Panel regularly revises the CPT code set, aligning it with current practices and innovations. They meet three times a year to review new applications or update the existing ones. Here are some basics you need to know about creating your own CPT code.
Why Create a Custom CPT Code?
If your medical practice utilizes novel technology or offers a service not currently addressed by existing CPT codes, a new code might be necessary for proper billing. Sometimes, existing codes might not accurately capture your service’s complexity or specific details. A custom code allows for more precise billing, ensuring your practice receives fair reimbursement for the services rendered.
Steps to Create Your CPT Code
Creating your own CPT code involves a few important steps:
1. Assess the Need for a Custom Code
Before proceeding with the CPT creation process, evaluate whether a custom CPT code is necessary. Review the existing CPT codes to determine if any current codes can accurately describe the procedure or service. The AMA offers resources and guidelines to help in this evaluation.
2. Document the Procedure
Compile comprehensive documentation to support the necessity of new code. This includes:
- Clinical Evidence: Submit relevant research studies, clinical trials, and case reports that validate the procedure’s efficacy and necessity.
- Usage Data: Demonstrate that the procedure is widely performed and accepted within the medical community.
- Economic Impact: Provide data showing the financial implications for both providers and patients, including the need for accurate billing.
3. Engage Stakeholders
Try to involve relevant stakeholders in the process, like the professional organizations representing your specialty that are best suited to initiate the application. If your service utilizes novel technology, industry groups associated with the technology can also be involved.
4. Submit an Application to the AMA
The American Medical Association (AMA) oversees the CPT code system. You could submit your application to the CPT Smart App. The formal application should include:
- A detailed description of the procedure that outlines the purpose, steps involved, and typical duration.
- Explanation of why a new code is necessary. Demonstrate how existing codes are inadequate for accurately capturing the specifics of your service.
- Resources (time, equipment) involved in performing the service.
5. Review and Approval
Following submission, the CPT Editorial Panel, a team of medical professionals, and other specialists who manage the CPT code set will review your application. This process involves multiple stages of evaluation and can take several months. During this time, they may request additional information or modifications to your proposal.
6. Implementation
Once approved, your new CPT code will be included in the next annual update of the CPT code set. You must educate your billing staff on the latest code and ensure it’s correctly implemented in your practice’s medical billing software.
The Role of Professional Services in Creating a Customized CPT Code
Working with a professional medical billing company can streamline the process of creating a new CPT code. They offer expert guidance on code necessity, assist with documentation and application submission, track application status, and handle follow-ups. Once approved, they provide staff training for effective implementation and simplify the process, letting you focus more on patient care.
Consider partnering with San Antonio Medical Billing LLC for expert guidance and support in creating customized billing systems for your practice. Contact us today, and let us help you optimize your practice’s financial performance!
