Page 134 - Encyclopedia of Nursing Research

CURREnT PRoCEDURAL TERMInoLoGY–CoDED SERvICES n 101

Building on the American Journal of services provided by the entire team. There
Nursing exploratory study survey, which are CPT codes that describe preventive ser-
described activities of generalist nurses, sur- vices and counseling; however, they do not C
veys were conducted to estimate the degree specifically describe nursing practice and are
to which nurses in nine specialties were not generally reimbursed by payers. In a study
performing CPT-coded services. Results comparing the frequency with which nurs-
revealed that 493 of approximately 7,000 CPT ing activity terms could be categorized using
codes were performed by school nurses, nursing Interventions Classification (nIC)
enterostomal nurses, family nurse practi- and CPT codes, findings revealed evidence
tioners (nPs), critical care nurses, oncology that nIC was superior to CPT for categorizing
nurses, rehabilitation nurses, orthopedic those activities in a study population of AIDS
nurses, nephrology nurses, and midwives patients hospitalized for Pneumocystis carinii
(Griffith & Robinson, 1992, 1993; Robinson & pneumonia. nursing activity terms were cate-
Griffith, 1997). The number of CPT codes per- gorized into 80 nIC interventions across 22
formed by specialty nurses ranged from 233 classes and into 15 CPT codes. These findings
for family nPs to 58 for school nurses. The supported the importance of nursing-specific
mean number of coded services performed classifications for categorization of health
by individual respondents ranged from 79 care interventions in an effort to demonstrate
for family nPs to 18 for school nurses; indi- nursing’s contributions to quality and cost
vidual respondents performed 0 to 162 codes. outcomes (Henry, Holzemer, Randell, Hsieh,
Supervision by physicians for these groups of & Miller, 1997). However, Sullivan-Marx and
nurses was infrequent. Charges to Medicare Mullinix (1999) believed that a better option
in 1988 for the coded services included in the would be to introduce nursing services into
survey were $22,793,427.34 (aggregate allow- CPT if they are not otherwise described in
able charges). another CPT code. In fact, since 1993, the
The Department of veterans Affairs (vA) American nurses Association has had a rep-
nursing Workload Capture Task Force, in an resentative on the Health Care Professional
attempt to identify and inventory current Advisory Committee to the CPT Editorial
mechanisms and/or methods of capturing Panel and has been directly involved in the
APn inpatient and outpatient vA workload, process of CPT code development and revi-
surveyed APns practicing in vA facilities sion (Sullivan-Marx & Keepnews, 2003).
across the country (Robinson, Layer, Domine, The Balanced Budget Act of 1997 (Public
Martone, & Johnston, 2000). Participants Law no. 105–33), which became effective
reported that their workload was being cap- January 1, 1998, amended the Social Security
tured primarily by using encounter forms, Act to grant direct Medicare reimbursement
CPT/ICD-9 codes, and productivity reports; to nPs and clinical nurse specialists in all
only a minimum of inpatient workload geographic areas and health care settings
was being captured. Sullivan-Marx, Happ, at 85% of the physician rate. This enactment
Bradley, and Maislin (2000), in another survey precipitated a study by Sullivan-Marx and
of nPs’ use of the CPT billing codes, found Maislin (2000) to ensure that there were no
that nPs performed services not identified significant differences in how nPs and phy-
in CPT codes that addressed comprehensive sicians assessed work values for commonly
patient care, attention to social factors, and used primary codes. The researchers com-
capturing the teaching moment. pared relative work values between nPs and
A longstanding criticism of the CPT family physicians for commonly used office
codes is their limitation to describe only phy- visit codes and found no significant differ-
sician services and not the full range of health ence between the two groups for establishing