CPT Consumer-Friendly Descriptors Become Friendlier

Introduction

Did you miss 2021 changes to AMA’s Consumer-Friendly descriptions? Today’s hospitals and health systems are heavily-focused on Price Transparency and public relations related to their charges. While hospital charge descriptors were historically created to internally communicate complex technical and clinical data, the need for clarity has now arisen in the public-view files. AMA’s Consumer-Friendly CPT-4 code descriptions are now a data element being evaluated by hospitals across the country.

In mid-January of 2019, a significant Consumer-Friendly Description datafile update was performed by AMA that Chargemaster Coordinators and Revenue Cycle teams should consider. This article discusses a high-level assessment of this field’s overhaul by AMA.

Background

CPT® Consumer-Friendly descriptions have been in existence for some time, but were never a reliable data element for wide-spread utilization in hospital charging master files. Not only were the code descriptors inconsistent and not fully populated, but some were inaccurate or incomplete. We have been reluctant to endorse use of this field in the past, since CPT does not follow the same formalized code update process as the ‘official’ CPT Long Description and code book contents. Since CDM Descriptions require more clinical detail for charge capture, verification, and auditing purposes than this field offered, the consumer field was not considered highly useful.

However, now that Price Transparency and other HIPAA-mandated interoperability requirements have been championed by CMS, there is a growing focus on providing patients with more understandable information about their charges. AMA recently promoted their Consumer-Friendly Descriptors in an effort to support transparency mandates.

As a hospital Charge Master or Revenue Cycle representative, you may or may not embrace AMA’s current version of their Consumer Friendly Descriptions for master file content in your organization. However, with a few refinements, it may be worth evaluating for use for public-facing pricing reference sources.

Recent Changes

Off-cycle from traditional CPT updates and unannounced until their release, in late-January 2021, the AMA provided an update file revising thousands of the Consumer-Friendly code descriptions. The updates can be found in ChargeAssist® Code Changes modules by looking for “Q1-C” in the quarter field and “2021” in the year field.

As we researched the history and AMA initiatives relative to this field, we located a 2017 Workgroup for Electronic Data Interchange (WEDI) presentation discussing the Consumer-Friendly code descriptions. The slide deck noted AMA’s goals to update this field in light of interoperability and transparency mandates. More recently, AMA promoted the updates to support CMS transparency mandates on its website. It noted that the existing CPT® Consumer-Friendly Descriptors lacked the specificity needed to accurately translate each code description in the official CPT® code set into language easily understood by the average patient.

AMA’s website discusses the Consumer Descriptors in the following article: https://commerce.ama-assn.org/catalog/media/consumer-and-clinician-descriptors-in-cpt-data-files.pdf[PAA1] 

Upon contacting one of the presenters from the 2017 webinar, we learned that the CPT Consumer-Friendly Description update process was outside of the formal CPT code set maintenance and management process. Future changes, we were told, may be sequenced in a similar timeline as other CPT code set changes, but this was not a formal acknowledgement or plan.

While we are not committed to endorsing or recommending this data field due to its lack of formality in the CPT update process, we will continue to evaluate the quality and efficacy of the updated content for public-facing pricing information.

Despite the utility and purpose of this descriptor field, H&A strongly advises against using the CPT Consumer-Friendly field for primary charge descriptors within CDM or EAP files.

Overview of 1Q 2021 Changes

On January 31, 2021, the AMA released 6,635 revised Consumer-Friendly Descriptors (representing a significant master file update). The revisions are found in ChargeAssist® by searching the Code Change modules for 1Q-C and the year 2021.

General Observations on 1Q 2021 Revisions

It appears that duplicate descriptors have been differentiated. While avoiding clinical terminology, verbiage was changed to more understandable layperson terms. Blank description fields have also been addressed.

Our high-level assessment of Consumer-Friendly descriptions is shared below. While this is not a comprehensive data element review, it does demonstrate some overarching concepts behind AMA’s undocumented descriptor updates.

Note: Remember than you can view all descriptor changes through the Code Change modules of ChargeAssist® and focus your view on only the consumer friendly changes for a complete internal analysis. The H&A team’s findings include the following:

• Blank and duplicated descriptors were updated.
  • 221 CPT codes with previously-blank descriptors were populated.
  • Near-identical descriptions were revised with distinct verbiage to eliminate confusion and to add clarity as noted in the example below.

• Format and terminology of many descriptions were standardized.
  • In the following Nuclear Medicine code examples, the inconsistency in the word order has been corrected to list the imaging modality of nuclear medicine as a prefix.
  • However, in the Diagnostic Imaging code examples shown below, the AMA workgroup has inadvertently created verbiage that may lead to potential patient confusion.
  • We are concerned that descriptions now read as if they are professional fees only which may create challenges to hospital technical component billing with the same codes. We expect that this verbiage would cause the patient to believe that the hospital should not bill these codes.

• Descriptors were refined and verbiage was rearranged.
  • For repair codes, key coding terms such as simple, intermediate, complex, open, or closed  were added in this revision version.
  • The numeric entries for size or other code qualifiers have been rearranged to the end of many descriptions.
  • Some potentially-confusing descriptions have been updated for better clarity as shown in the revisions below.

• Key qualifier terms were added.
  • As shown with the following surgical range codes, clinical detail was added to differentiate procedure details.
  • The gait training code was revised to note that it is a therapy procedure.

• Anatomic site specificity was refined.
  • In the anesthesia code below, CPT added verbiage to reference all anatomic areas represented by the code.

• Billing units were added.
  • As noted in the medication therapy management example below, the time increment (a key term for charge verification) has been added.
  • Views for imaging were corrected for consistency with CPT Long descriptors.

Flaws Still Exist

In our analysis, we located inactive codes in the current CPT Consumer Description file. Be sure to rely on current CPT data sources such as our licensed data in ChargeAssist®. For example:  87450 was deleted off-schedule from the 2021 CPT updates by AMA and is not an active code, yet was included in the CPT consumer friendly file.

Some changes may lead to confusion such as removing the MRA abbreviation and replacing it with MRI.

An example of overly-generic verbiage is displayed in the Consumer-Friendly descriptors for E&M outpatient visits, consultation codes, and ED visit codes. Key verbiage in the new 2021 outpatient visit E&M complete CPT descriptors is missing. This may lead to patient questions since only ‘typical time’ is listed.

CPT Short Descriptions – Use with Caution

We continue to suggest avoiding utilizing CPT Short Descriptions for Charge Master datafiles or public view files.

CMS publishes HCPCS Level II short descriptors and AMA maintains its own short description data element with all published in CPT/HCPCS Masterfile releases. The following exhibit shows the short descriptions compared to Complete (Long) Descriptions and Consumer-Friendly Descriptors. 

Best Practices for Descriptor Options

We suggest to our customers that use of any commercially-developed charge master descriptions should be evaluated and carefully considered prior to use.  Industry-experience shows that often, internally-developed charge descriptions within your own HIS system field length limitations are best to utilize.

The Consumer-Friendly Description updates from AMA do warrant consideration, as this descriptor field may be favorable for the Shoppable Services files or Price Estimator software tools.

H&A has published articles and trained organizations on Charge Master Management best practices relative to Charge Descriptors for decades. We suggest review of our Charge Description articles, found through the Document Search function. (Search for either the phrase Charge Description, or use a Boolean search for Charge w/5 Description[PAA3] ).

2017 Holliday & Associates articles that may be of interest:

• CDM Management Strategies: Improving Charge Descriptions: Part I – Charge Description Risks, Influences, & Improvement Strategies
• CDM Management Strategies: Improving Charge Descriptions: Part II – Charge Description Assessment

Summary Recommendations

While H&A believes that the upgraded Consumer-Friendly descriptors are much-improved, we still suggest close scrutiny prior to adoption. We strongly believe that the Consumer Friendly fields should not be utilized to populate the Charge Description field of CDM master files.

If your organization has cultivated charge descriptors over decades, trust your processes. For many hospitals, CDM Descriptors have been fine-tuned to provide industry-standard verbiage, specificity to the assigned service and codes, and organization-specific syntax and abbreviations.

However, for hospitals that have adopted flawed charge descriptors, it may be time to evaluate Charge Master descriptors along with Consumer-Friendly descriptors for the Shoppable Services files (or price estimators). 

ChargeAssist® users should note that Consumer-Friendly Descriptors are available through the tool, and can be easily integrated into Public Portal CDM data or internal working files.

As a final tip, we suggest defining an organizational strategy surrounding which AMA and CMS descriptors are used and how. This will avoid an unanticipated loss of data quality with file changes that could impede auditing and monitoring of charge and claims data.

Charge Management Take-Away

Watch for future updates as CPT continues to focus on this important file. We expect even more changes in the coming years.

If you’d like to learn more on basic Charge Master Management processes and techniques, consider our 12 hour CDM Management Educational Program for Chargemaster Coordinators and Revenue Integrity Teams. Feel free to contact our Managing Partners, Rosemary Holliday at Rholliday@chargeassist.com or Bud Carrroll at Bcarroll@chargeassist.com to discuss your team’s specific Charge Management needs.

Holliday & Associates provides our Charge Master software, education, and consulting solutions to hospitals and health systems of all sizes across the country. ChargeAssist® is our web-based HFMA Peer Reviewed® Charge Master tool for auditing, collaborating, researching, and workflow processing for all system masterfiles impacting charge data. Since 1990, we have provided Charge Management Strategic Support, CDM Coordinator Education, and Charge Master Review engagements.  Contact information: (800) 831-3323 Web Site: www.ChargeAssist.com  Contact information: info@chargeassist.com