Healthcare Business News

Genetic-testing CPT codes shared with federal registry

By Andis Robeznieks
Posted: January 17, 2013 - 6:00 pm ET

New and more-detailed Current Procedural Terminology codes for genetic testing will be incorporated into the National Institute of Health's central registry, a move described as a boon to both the clinical and business management side of medicine. Until now CPT codes have been generally seen as billing tools for insurers.

The new codes were developed by the American Medical Association. In an agreement between the AMA and the National Library of Medicine, the codes will be put to use in the NIH Genetic Testing Registry. Dr. Wendy Rubinstein, director of the GTR, said the move helps create an “interoperable terminology” allowing better communication between clinicians, hospital management, laboratories and payers.

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“There are a lot of information silos all over the place and it's hard to make them all talk to each other,” Rubinstein said.

While the codes may be a billing tool, they have uses that go beyond processing payments and that help “give a global view” of the practice traffic patterns within the U.S. healthcare system, she said.

“We're helping systems to talk to each other, and we're helping payers and regulatory agencies get a better picture of what's happening,” Rubinstein said. “Hospitals have to grapple with what's being ordered and what's being paid for, so this information is very helpful.”

By having more-specific codes and having the information about them stored in a central registry like the GTR, Rubinstein said it helps clinicians “understand better what's going to happen” with a particular test. She said this means, not only will clinicians know what condition a particular test looks for, but also what genes it targets and how deeply it looks into them.

Rubinstein added that the science and popular thinking about genetic tests are changing.

“Traditionally, they are thought of as tests for rare diseases that you'll never get or that anyone you know will never get,” she said. “That has turned around.”

Rubinstein explained how diabetes, heart disease and osteoporosis all “have a strong genetic component,” and the universe of available tests has expanded to include them.

The news release also noted that more than 100 codes have been created, and this “advances the AMA's overarching goal of reducing disease burdens, improving health outcomes and reducing long-term-care costs.”

The CPT codes are also a lucrative revenue source for the AMA. In its annual reports, CPT-related income is included under “books and products” in the publishing and business service revenue category. According to its 2011 annual report, this category includes “AMA-published books, AMA affinity products and the coding products, such as CPT books, workshops and licensed data files.” Revenue from this source increased to $79.1 million in 2011, up 5.5% from $75 million in 2010. The increase was “largely in CPT,” according to the report, and was “offset by a 2.8% decline in book sales.”

Rubinstein didn't see profit as a motive in this agreement.

“We're happy that the AMA worked with us to make these codes available to the public,” she said. “I see generosity and sharing on their part.”

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