Page 133 - Encyclopedia of Nursing Research

100 n CURREnT PRoCEDURAL TERMInoLoGY–CoDED SERvICES

explorations of cultural perspectives on eth- Part B providers (Robinson, 2009; Robinson,
ics. Folk and alternative healing practices and Griffith, & Sullivan-Marx, 2001).
C their possible combinations with biomedical The Physician Payment Review Com-
approaches need systematic, sensitive study. mission was created in 1986 to advise the
Studies of cultural adaptations of care in Congress on reforms of the methods used
homes, development of brief rapid strategies to pay physicians under the Medicare Part
for cultural assessment, and development of B program, a program that includes the pay-
the economic case for culturally competent ment regulations for health care professionals
care are needed to insure that culture is con- who are eligible to receive direct reimburse-
sidered in this era of managed care, case man- ment through the Medicare program. Carol
agement, and ever briefer inpatient stays. Lockhart, PhD, Rn, FAAn, the first nurse to
serve on the Commission, expressed concern
Sharol F. Jacobson about the lack of nursing data available that
would reveal how many services are deliv-
ered by a nurse but billed under the physi-
cian’s name (Griffith & Fonteyn, 1989).
Current proCedural In an attempt to identify whether CPT
terMinology–Coded codes might explain nursing work and
thereby provide the needed data, studies
serviCes were conducted to look at how many billable
CPT activities were performed by nurses
(Griffith & Robinson, 1993; Griffith, Thomas,
Current Procedural Terminology (CPT)– & Griffith, 1991; Robinson & Griffith, 1997).
coded services include more than 8,000 Initially, Griffith and Fonteyn (1989) pub-
services listed in the Physicians’ Current lished a questionnaire, in the American Journal
Procedural Terminology manual pub- of Nursing, addressing the performance of
lished annually by the American Medical CPT-coded procedures by registered nurses;
Association (AMA). Developed by the AMA 4,869 nurses returned the questionnaire and
in 1966, the CPT coding system, which mainly 150 made telephone calls or wrote letters.
describes physician procedures, is intended The average number of coded services per-
to provide a uniform language that accu- formed by the respondents was 27, with a
rately describes medical, surgical, and diag- range of 0 to 60 (Griffith et al., 1991). There
nostic services (AMA, 2007). The CPT serves are currently approximately 8,000 published
as a method for payment by public (Medicare codes in the manual, but at the time of the
and Medicaid) and private (commercial survey in 1989, only 107 codes comprised
insurers) payers. It is also used by policy 56.9% of all Medicare procedures (Health
makers in their deliberations on reforming Care Financing Administration and Bureau
the payment system. CPT is revised annu- of Data Management and Strategy, 1990).
ally to reflect changes in medical practice Survey results revealed that associate and
and technology. Reimbursement to a ser- baccalaureate degree nurses performed sig-
vice represented by individual CPT codes is nificantly more coded services than nurses
based on the Resource-Based Relative value with diplomas and masters degrees. overall,
Scale, which was originally implemented the nurses reported very little physician
to establish a Medicare fee schedule for supervision when performing the coded
Part B physician payment. This system now services. As one would anticipate, nurses
extends to payment for services provided by working in hospital settings performed more
advanced practice nurses (APns) and other services (Griffith et al., 1991).