Professional Coding: Parts 1, 2 and 3

This article was originally published on our sister-website, "Audiology Online" (www.audiologyonline.com) and is republished here with permission. The editors of both websites believe this article has application for Speech Language Pathologists and is offered here for educational and academic purposes.

Editor's Note - Professional Coding: Parts 1, 2 and 3 were originally written and published as separate, concise articles. For CEU purposes, we have combined the original three articles, learning outcomes and examinations, into one larger, comprehensive document. Thanks, ---Editor

Professional Coding: Part One - Clinical Coding: CPT

In response to requests for information on procedural and diagnostic coding, I am writing the first of a multi-part series.

This first section will address CPT (Current Procedural Terminology) coding. Part Two will focus on ICD-9 diagnosis coding. Part Three will deal with V-codes, HCPCS, and the new CPT-5 and ICD-10 codes.

CPT codes are copyrighted and owned by the American Medical Association. These codes were established in the mid-1960s. The first CPT manual was published in 1983. The codes were written by physicians for physicians with no consideration of non-physician health care professionals. They were established as a first step toward standardizing health care terminology and to provide a means of objectively tracking services rendered.

As those of us who were in practice in 1983 will recall, if someone had asked you what your facility called a basic evaluation, the responses would be ''Comprehensive diagnostic evaluation'', ''Basic audiological evaluation'', ''Audiological assessment'', ''Basic evaluation'', ''Comprehensive evaluation'', and so forth. The point is, there were as many descriptors as there were clinics. Insurance companies had no standardized gauge by which to judge the value of our services. As a result, the AMA established a formal editorial panel to examine all medical procedures (of which speech, language, and hearing services were included). The AMA solicited input from various specialty disciplines. The section of the manual that covers what we do collectively is known as ''Special Otolaryngology Procedures''.

During the decade of the 1980s, the cost of health care skyrocketed. There were various reasons for this, perhaps the most famous of these was ''physician greed''. Without a doubt, that was a contributing factor, but I submit it was a relatively small part of the entire picture. Another part of the picture was ''Managed Health Care,'' which too, established a foothold in the 1980s. The first appearance of managed health care was in the form of HMOs and then various forms evolved. Several of the first HMOs were established by physician groups. The first HMOs were ''prepaid'' plans through which health care could be provided in a more cost effective manner. These prepaid plans quickly evolved into managed care plans as indemnity insurance companies became part of the picture. Also of note, through the 1970s and into the 1980s, insurance companies started to sell individual policies to single persons or to families. Employer supplied health insurance existed but was not necessarily the predominant factor in non-union situations.