Chapter 1
What Changed?
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nless you were trained more than thirty years ago, you might be asking, What’s the issue? From your perspective, practicing medicine has always been this way. You’re probably wondering why some in this profession complain about the current system and think, They just need to adapt! But that’s because you have never worked in the old system, where healthcare delivery was more of a mission and less of a business, and you’ve likely never practiced medicine without Relative Value Units (RVU) or Current Procedural Terminology (CPT) codes. Although the Accreditation Council for Graduate Medical Education (ACGME) requires training regarding billing and coding during residency, very little attention is paid to these seemingly mundane issues in reality. So a bit of history is needed to communicate what has changed and how we got to where we are today. The American Medical Association (AMA) first developed Current Procedural Terminology codes in 1966.1 The first edition was developed to simplify and bring consistency to the description of procedures and services. They were intended to help providers describe what they did more easily so record clerks could understand. The codes had nothing to do with reimbursement. In 1970, the second edition of the codes expanded to five digits and began including lab tests. Not until 1983 were the codes tied to billing. In that year, the Health Claim Financial Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), merged CPT with its own 25
