Sen. Bill Cassidy, R-La. Credit: Cassidy
A top U.S. health care policymaker is clashing with the American Medical Association over an AMA program that shapes how employers' health plans work.
The AMA has been running the Current Procedural Terminology code program — which develops the codes that health care providers use to describe medical procedures — since 1983.
Sen. Bill Cassidy, R-La., the chairman of the Senate Health, Education, Labor and Pensions Committee, says in a public letter that the system the AMA uses to run the CPT code program is an "abusive monopoly" that may charge providers and others too much for use of the codes and may fail to get enough input from stakeholders about the codes.
Cassidy cited the CPT codes related to the treatment of gender dysphoria in children as examples of problems with the CPT code program.
"I am concerned that the status quo focuses on enriching the AMA at the expense of patients, while the organization subsequently uses the revenue to advance a political agenda that is not representative of the majority of the medical community," Cassidy wrote in the letter, which was addressed to Dr. Bobby Mukkamala, the president of the AMA.
Cassidy has asked Mukkamala to answer questions about the CPT code program by Dec. 15.
"If you are unable to voluntarily reply in a fulsome and timely manner, the committee will consider other options to secure the information requested from the AMA," Cassidy said.
Representatives for the AMA were not immediately available to comment on the letter.
What it means: The CPT code system could soon get more attention in Washington.
Any hearings, meetings or other efforts could give employers and health plan administrators a chance to raise any concerns they have about either CPT codes or the International Classification of Diseases, Tenth Revision, Clinical Modification diagnostic code system.
The backdrop: The CPT procedure codes and the ICD-10-CM diagnostic codes are at the heart of health plans' claim administration systems and of many of the tools patients, employers, plan administrators, benefits advisors and others use to determine what care will really cost.
Some have suggested that the CPT coding system and another frequently used coding system, the I, or ICD-10-CM, have become so complicated that the U.S. health care system now has an urgent need for artificial intelligence systems simply to manage the coding.
Health care providers and health plan administrators have accused each other of using AI-driven coding systems that misrepresent the nature of the conditions treated and of the care provided.
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