Representing Medical Procedures Performed

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Type Standard Implementation/Specification Standards Process Maturity Implementation Maturity Adoption Level Federally required Cost Test Tool Availability
Standard
Final
Production
Rating 5
Yes
Free
N/A
Standard
Final
Production
Rating 5
Yes
$
N/A
Standard
Final
Production
Rating 5
Yes
Free
N/A
Standard
Final
Production
Rating 4
Yes
Free
N/A
Limitations, Dependencies, and Preconditions for Consideration Applicable Value Set(s) and Starter Set(s)
  • ICD-10-PCS  is primarily a billing code used only in inpatient settings.
  • CPT and HCPCS are codes used to report procedures and services in outpatient srocedures.
  • ICD-10-PCS is named in the 2015 Edition certification rules as an optional code set for procedures.
  • SNOMED CT procedure codes can be used to describe treatment in any clinical setting and is not tied to billing, but can be cross-mapped to corresponding ICD-10-PCS and CPT/HCPCS codes.
  • Feedback requested

Comments

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On behalf of American Medical Association (AMA) I appreciate the ability to comment on the 2018 Interoperability Standards Advisory (ISA).

Comment:

Under “Limitations, Dependencies, and Preconditions for Consideration,” the AMA recommends that “CPT” be removed from the statement – “CPT/HCPCS are billing codes used for Outpatient Procedures.”  The CPT code set is mandated and widely used for claims processing, but it also serves in various functions outside of billing, including medical care review guidelines, medical education, patient outcomes, health services, and quality research.