Expert Agreement in Current Procedural Terminology Evaluation and Management Coding

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Abstract
DURING THE past decade, the Health Care Financing Administration (HCFA) has revised the Current Procedural Terminology (CPT) coding guidelines in an effort to clarify the work of physicians. Prior to 1992, fee schedules for physician's services were determined by a customary and reasonable charge method.1 In 1992, this fee schedule was changed and replaced by a system based on relative-value units and conversion factors. To implement this system, a new CPT coding system was used, and in 1995, HCFA developed guidelines for use of this new CPT coding system. Use of CPT evaluation and management (E/M) codes for a patient visit requires determining the level of history taking, physical examination, and medical decision making for the patient and matching the combination of these 3 elements to the proper CPT E/M code. These guidelines provide physicians and insurance carriers a format for determining the proper coding level based on medical record documentation. Continued efforts to refine and standardize the guidelines across specialties led to development of new guidelines in 1997 and plans for additional guidelines in 1999, which are still in development.