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The AAN's Role in Advancing Coding and Reimbursement for Neurology

An important component of a successful neurology practice is correct coding and claims submission for the critical services provided by a neurologist. The AAN strives to ensure appropriate reimbursement for neurology and to provide coding resources to support members and answer their questions quickly. This is especially critical given the rapidly changing landscape of health care. Physician volunteers and Academy staff participate in several external processes and strategic discussions that have allowed the AAN to be “at the table” when it comes to proposed payment changes that impact our members.

How the AAN Participates in the CPT Process

The Current Procedural Terminology (CPT) code set created by the American Medical Association (AMA) is used to bill outpatient and office procedures. These five-digit codes provide a standard system to report medical procedures and services under public and private health insurance programs. The AMA’s CPT Editorial Panel meets three times each year to discuss and approve any CPT code additions, deletions, and revisions. The AAN has appointed several members as CPT advisors who review all proposed changes and, where appropriate, submit comments or requests for changes on behalf of neurology. The panel considers these written comments. AAN representatives and staff attend panel meetings and speak about any issues of relevance to neurology. The AMA publishes an updated CPT manual on an annual basis. New and revised codes are released in August with the publication of the AMA’s CPT® Professional and go into effect the following January. Because the AMA maintains the rights to the CPT code set, societies are bound by its confidentiality rules until the embargo lifts each year.

How the AAN Participates in the RUC Process

The next phase of the process is an annual update to the physician work relative values. These values are based on recommendations from a committee involving the AMA and national medical specialty societies, known as the AMA/Specialty Society Relative Value Scale Update Committee (RUC). The RUC acts as an expert panel in developing and delivering relative value recommendations for new or revised CPT codes to the Centers for Medicare & Medicaid Services (CMS). The RUC gives physicians a voice in shaping Medicare relative values. The RUC represents the entire medical profession—including the AAN, which holds a permanent seat on the committee. Academy members and staff attend the RUC meetings (also three times a year) to share recommendations on physician work and practice expense inputs (including staff time, equipment, and supplies) for codes.

How Can Members Get Involved?

The recommendations presented by the AAN are based on survey data on the time and intensity of a given service. The AMA has a standard survey tool that is used by all medical specialties when surveying a CPT code and is distributed to physician members within the organization who are familiar with the service. If you receive a RUC survey from the AAN, please take the time to participate in this important process. The survey is the crucial foundation upon which the AAN develops recommendations to be considered by the RUC. Annually, the AMA submits the RUC recommended values to CMS, which has the final decision on payment rates that are published each year in the CMS Physician Fee Schedule. AAN coding and regulatory staff work as a team when anticipating new CPT codes and determining the need for outreach to CMS officials to raise awareness on the value of services provided by neurologists.

 

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