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AMA to study establishing coding combinations, modifiers
■ Standards could help ease the controversy over bundling and downcoding.
By Katherine Vogt — Posted July 5, 2004
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Chicago -- The AMA has decided to study the feasibility of developing a national standard for using codes, code combinations and modifiers that could help clarify when it is appropriate to bundle services for coding.
The study, ordered by a resolution adopted by the House of Delegates on June 15 during the AMA's Annual Meeting in Chicago, would examine a national standard that is consistent with CPT guidelines and could be used by all commercial and government payers.
Such a standard could help address the controversy over bundling and downcoding, practices at the heart of major lawsuits brought by physicians against insurers. Though AMA has policies that denounce the practice of unfair bundling and downcoding by payers, it has never formally studied developing a national standard for code combinations.
In discussions leading up to the resolution vote, Bohn D. Allen, MD, an AMA delegate and president of the Texas Medical Assn., said that being paid fairly and correctly can be a challenge for physicians. He said organized medicine should advocate a national standard to ease the burden.
"Bundling and downcoding have been the bane of our existence," said Dr. Allen. Setting a national bundling standard, he added, could help create a legacy to ensure that future physicians are paid fairly.
In a written statement after the resolution was adopted, Dr. Allen said the study would be "a major step to reduce the cost of filing for insurance reimbursements and to add predictability to the process."
The issue has heated up in recent years, with physician groups suing insurers over claims payments. Large settlements were reached with CIGNA HealthCare and Aetna. Similar lawsuits are pending against a half-dozen other insurers.
