LOUISIANA STATE MEDICAL SOCIETY
AM 2024 DESTIN
HOUSE OF DELEGATES
RESOLUTION 106
SUBJECT:
Policies Concerning Code Sets Mandated for Use In Claims Processing And Payment Under The Authority Of The Centers For Medicare & Medicaid Services (CMS)
INTRODUCED BY:
Frederick J. White, III, MD
WHEREAS, ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) codes are used by all physicians and providers in every healthcare setting to code for diagnoses, and are developed and maintained by the Centers for Disease Control & Prevention (CDC), National Center for Health Statistics (NCHS), and WHEREAS , the U.S. Department of Health and Human Services (HHS) mandates that everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) implement ICD-10 for medical coding, and WHEREAS , ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) codes are free and can be obtained from the CMS website, and WHEREAS, the Healthcare Common Procedure Coding System (HCPCS) is a standard national medical code set specified for the purpose of ensuring that claims are processed in an orderly and consistent manner, and WHEREAS , HCPCS is divided into two principal subsystems, referred to as Level I and Level II of the HCPCS, and WHEREAS, HCPCS Level I codes are part of the Current Procedural Terminology (CPT®) code set maintained by the CPT® Editorial Panel and copyrighted by the American Medical Association (AMA), and WHEREAS , HCPCS Level II codes are established and maintained by CMS, and are not copyrighted, and are in the public domain, and WHEREAS , in 1983 the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services, or CMS) granted the American Medical Association what has been characterized as a statutory monopoly by agreeing to exclusively use and promote the AMA copyrighted Current Procedural Terminology (CPT®) code for the purposes of reimbursing Medicare and Medicaid bills from physicians and providers for outpatient services, and WHEREAS , as a result of the HCFA endorsement of the AMA copyrighted outpatient codes, to the exclusion of all competitors, private insurance companies and others were also forced to adopt the CPT® as their billing standard as well, and
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