Be aware that there’s a new icon next to some codes in the 2010 CPT manual. It’s the hash-mark symbol “#,” and it’s being used to designate code numbers that are out of numeric order – a completely new concept for the CPT code book.
It appears the American Medical Association (AMA) is unveiling a new strategy to help provide much-needed room for expansion. The association is calling it the CPT “resequencing initiative,” and explains it this way:
“Resequencing of CPT codes allows placement of related codes to an appropriate location regardless of the availability of code numbers for numerical placement. This initiative also allows the CPT code set to expand and grow as a HIPAA designated code set and demonstrates the capacity to respond to today’s health information technology (HIT) requirements.”
So, don’t let the name fool you; in this case, “resequencing” has nothing to do with the order in which you list codes on a claim. One example you’ll see is neck tumor excision code 21556. The AMA apparently wanted to revise it to designate tumors of varying sizes. But there was a problem: CPT already contains codes 21555-21557 in numeric order – no room to add another code to the family.
So, as part of the 2010 resequencing initiative, code 21556 will read, “Excision, tumor, soft tissue of neck or anterior thorax, deep, subfascial, (e.g., less than 5 cm).” Then, after it, you’ll see “#21554 – … 5 cm or greater.” After that, you’ll find radical resection code 21557. In other words, “available” code number 21554 will appear in the CPT manual – with the # symbol – between “already taken” code numbers 21556 and 21557.
To understand why CPT is breaking its long tradition of numerically sequenced code families, you must step all the way back to May 1998, when a Notice of Proposed Rule Making (NPRM) regarding Administrative Simplification criticized the CPT code set as “not always precise or unambiguous” and limited in its growth capacity due to its hierarchical structure. (You may remember that ICD-9-CM shared the same censure.)
With the benefit of hindsight, of course, we know that CPT nonetheless was chosen as the standard code set for electronic physician service claims. Still, those criticisms have driven some of the changes we’ve seen over the past several years – from the deletion of the phrase “with or without” from many code descriptors to the renumbering of entire code sections (for example, this year’s injection and pediatric E/M codes). Now, rather than delete and renumber code families that have “outgrown” their allotted space within the manual, the AMA is attempting a new way to work around CPT’s inherent size limitations.