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Trisha Torrey

The AMA and CPT Codes - Getting Picky and On My Case

By January 17, 2011

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Two years ago I wrote one of my first articles about CPT codes to help those of you who research these codes to help you decipher your medical bills.

As you may know, the AMA (American Medical Association) owns and copyrights CPT codes. Last week, I was contacted by the AMA's media relations person, Robert Mills, insisting that I remove two statements from the article, claiming those statements were "gross mischaracterizations" and "deliberate distortions" - although later Mr. Mills conceded that he wasn't describing MY article. Instead he was describing my sources for that information.

Statement #1 he wanted removed, said that the AMA makes $70 million per year from their CPT code business. Now - I don't make these numbers up! I got that information from four different sources, including two citations from the Wall Street Journal. Their sources were AMA Annual Reports.

Mr. Mills sent me a copy of the most recent AMA Annual Report from 2009. I checked it out - and learned that for books and products, the AMA brought in $70.9 million in 2009. They brought in an additional $103.4 million for "database products" and "publications." (see the screenshot above, stated in millions.) Mr. Mills explained that there are 100 books and products, and CPT coding is only one of them. However - the AMA licenses its CPT databases, and publishes plenty of books, pamphlets, etc about CPT codes. That total looks to me like $174.3 million... but CPT is not included in database products or publications, according to Mr. Mills... (?)

Hmm. Fuzzy numbers. One of the supposedly errant source reports I relied on was published 10 years ago, yet it remains available to be read online. If they made $70 million a year 10 years ago, then it's VERY DIFFICULT to believe they aren't making that much today.

So I have to wonder why the AMA isn't clearer in its reporting? Clarity would mean Mr. Mills wouldn't have to spend his time chasing down articles like mine, then having to show writers like me the (ahem) error of my ways.

Statement #2 he wanted removed, said that the AMA does not make a list of their CPT codes available to the general public. Well guess what -- that's true! There is no free, publicly available list of codes to be had that I can discern. There are places to look up the codes individually, but no public list is available that I can find. Mr. Mills insisted that CMS makes the list available, but when I asked him to send me a link, he replied, "The CMS public affairs office can direct you to the location of their CPT list."

Yes, the AMA developed the codes, and copyrights the codes, and they have a right to make a profit from them. CPT codes are a valuable part of our private for-pay healthcare system. What makes no sense is why the AMA's Media Relations Department would be so insistent that the $70 million number be removed from an article. Why take their time with it? Why did they wait for two years? And why have they not disputed it in those other articles where it was sourced?

Right now the AMA is taking hits for several problems. Estimates are that the AMA represents only 15 - 18% of all doctors. Many of its members are upset that it supported healthcare reform. Even those who also supported healthcare reform are skeptical about the AMA's reasons for doing so.

But those points don't explain why the AMA felt it so necessary to get all over my case over two seemingly innocuous points in an article about CPT codes.

I've always believed that if something doesn't make sense, then there is something I don't know. In this case, I have to wonder what bomb is about to drop, what big change is about to take place, what hits the AMA is about to take over these seemingly small details....

Stay tuned. I'll let you know when it happens.

Learn more about medical codes - CPTs, HCDCS codes, ICDs, DSMs and more.

Learn more about CPT codes, why they important, and how to look them up.

Learn how to decipher your medical bills.

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Screenshot above taken from the 2009 AMA Annual Report

Comments
January 19, 2011 at 1:18 pm
(1) WatchingDog says:

Thanks for covering these issues which have significant impact on patients and caregivers. We need more independent, investigative watchdogs advocating for patients and caregivers, especially against the entrenched powers such as the AMA, which have their own adgendas.

By taking the considerable time and effort (and heat from AMA, apparently) to investigate and inform, you are walking the walk of advocate for us all. I, for one, greatly appreciate what you do.

January 21, 2011 at 11:53 am
(2) NavyVet says:

The real travesty here is the impediment the current CPT codes impose on a rational payment system. The CPT panels are lead primarily by surgeons, as they were the most prolific users of the procedure codes 30-40 years ago, so they dominate the process. Important specialties like oncology, endocrinology and rheumatology are NOT represented, as they did not get one of the 29 seats at the table. Not surprisingly, the highest paid medical specialties are surgeons as they control the process. No rational planner would structure such a stupid, corrupt system today, so the obvious omission of CPT coding reform as as a primary component of Obamacare can only be explained as part of a massive kickback to AMA to secure crucial political support early in the health care debate. There is no rational defense of the current system, which still relies solely on measuring and rewarding activity – not results or quality. ALL of the serious proposals for reforming this system start with an understanding that the basis for reimbursement must shift to metrics linked to outcomes. The antiquated CPT system is blind to outcomes or any kind of quality assessments. As a result, we incentivize activity – even stupid procedures that will never affect outcomes are highly paid. This is madness.

The AMA is the Enemy! They only protect the poobahs in Chicago, and they hide behind their lawyers and their corrupt political cronies to evade scrutiny.

Where is Darrell Issa when we need him? I would love to see these jackals from AMA sitting at the green felt table explaining themselves under oath in the 112th Congress.

June 20, 2011 at 10:57 am
(3) AMA alternatives says:

Thanks for the article and standing tough under the gun.

An AMA CPT procedure code list is NOT freely available on the CMS website, as suggested by AMA. In fact, the CMS page at http://www.cms.gov/TransactionCodeSetsStands/05_CodeSets.asp clearly states that the “CPT-4 codes can be purchased from the American Medical Association at 1-800-621-8335.”

August 5, 2011 at 5:12 pm
(4) Corpsman27 says:

NavyVet I can’t say how much I appreciate the truth behind every word in your comment.

February 7, 2012 at 7:23 pm
(5) Martha Gregro says:

Thank you so much for your research and article. By standing by your work, you have informed and inspired.

My dermatologist is battling the cpt/icd9 coding system- by not billing! As a patient, I bill the insurance company for my procedures. Now I understand the obstacles that the AMA has created with these codes.

I wonder if the AMA and insurance companies have an ‘understanding’? What are the salaries of the AMA administrators? Insurance company administrators?

The AMA appears to be still using leeches as a treatment-for sucking money from their patients.

May 17, 2012 at 11:45 am
(6) HCIT Guy says:

The CPT codes are not freely available on the CDC web site, but the ICD-9 CM HCPCS codes are. It just turns out that the HCPCS Level 1 codes are based on the AMA’s CPT codes.

Prior to 1996, the HCPCS codes were optional, since the HIPAA laws came out, these have been mandated. As far as I can tell, any copyrighted material that is encorporated into law becomes Public Domain in the USA.

May 17, 2012 at 12:21 pm
(7) HCIT Guy says:

Just as soon as i say that, i noticed that the CMS HCPCS downloadable file explicitly does leave out the Level I codes (CPT codes).
I still think that if it is federally mandated that it belongs in the Public Domain.

April 9, 2013 at 7:44 am
(8) CodeMonkey says:

You are correct. CPT codes are trademarked and copyrighted to the AMA. Which got the US Gov’t /through the Centers for Medicare/Medicaide (CMS)/ to mandate them as the ONLY way to report services rendered to Medicare/private insurance.

A bundle of CPT & ICD-9 & HCPCSII codes will set you back somewhere around $180 give or take. CPT by itself is about $100.
The two main organizations representing us coders are
The American Health Information Management Association (AHIMA), and
the American Academy of Professional Coders (AAPC).

April 10, 2013 at 4:28 am
(9) lisa says:

wow! very interesting article…so much subterfuge within our current medical system.

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