Revenue integrity tips for CPT/HCPCS updates

by Lisa Kanivetsky, BA, CPC, CHRI

Dependent on your department and organization structure, the annual CPT/HCPCS updates may fall under your purview. If they do, this can be a stressful, overwhelming, and laborious process. My team at Hennepin Healthcare in Minneapolis, Minnesota, is responsible for the updates from both a content and Epic-build perspective, as well as for the communication, education, new workflow implementation, and pricing. One could deduce that chaos reigns during this time, but with a detailed project plan and solid timeline management, we emerge each year fairly unscathed.

I’ve listed a few high-level concepts and steps from our project plan which has led to our success.

• Start early. We download the AMA CPT file as soon as it become available (typically right after Labor Day). The CMS HCPCS file is usually available sometime at the end of October or beginning of November. In the AMA file, we use appendix B to identify all the new, deleted, and modified codes.
• Utilize deleted codes. We use the deleted codes to identify the charge records built, as well as which department in the organization is using them. Verify if the code can be remapped to a newly release code.
• Engage. Have a kickoff, engage all of the organizational stakeholders, and share timelines. Then, have weekly touch base meetings to address questions.
• Attend the AMA CPT symposium. We send 1–2 team members, who then bring the information back to the group, and we only finalize our build and mapping after the symposium.
• Update. Sequence system updates and moving the files through the non-production environments (for reference, our organization uses Epic).
• Educate. Provide end-user education and memorialize the change in an end user communication to have available for future reference.
• Monitor. QA all files in all environments. Monitor after implementation for a predefined time.