Current Procedural Terminology (CPT) is a medical code set that is used to report medical, surgical and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organisations. Earlier, most hospitals were using the 2012 CPT coding version.
This is being done in preparation of the Diagnostic Related Group (DRG) system of payment and management of medical services to be introduced by the first quarter of 2020 across all health care facilities.
What coding means for the patient
Dr Ganesh Rajamani, head of provider management at Neuron, a Third Party Administrator (TPA) in health insurance, told :
“The biggest issue is of fraud, wastage and abuse of the health insurance system, and CPT coding will help eliminate that by providing clarity in the billing system. Eventually the common man will stand to gain as insurance premiums will not be raised when insurance companies are assured that they are paying for what is rightfully determined.”
“The CPT software will include all medical procedures that hospitals offer here and the payment system will be segregated into bundles or package systems. Depending on categories of mild, moderate or severe, the prices of the procedures will vary. Each such package will include the price of the procedure with diagnosis, consultation, medicine and length of stay charges.”
Giving an illustration of how the price will be determined, Dr Rajamani said: “A patient who is diagnosed with say, appendicitis and has to undergo appendectomy will fall into a simple category. However, if the appendix is already ruptured, the category might change to moderate and if the patient has many other co-morbidities such as a diabetes or hypertension, then he might fall in to the severe category. Once the categories are set, there is a standardised treatment protocol, diagnostic tests, length of stay etc and the medical transcriptionists and coder will be able to accurately determine that. Payments will be set on the basis of the category or bundle the treatment falls into. This provides greater ease of settlement of insurance payments.”
According to Humaid Al Qutami, director-general of DHA, “The introduction of CPT coding is a milestone for the health system in Dubai. It will make the medical billing process highly efficient and accurate with minimum human interference and it will empower all stakeholders to become completely paperless. Additionally, it will also enable accurate data collection that will help us devise evidence-based policies and processes to further enhance the healthcare system in Dubai.”
Saleh Al Hashimi, CEO of Dubai Health Insurance Corporation (DHIC), explained that CPT would provide Dubai a unified and streamlined language for all healthcare providers, insurance payers, third party administrators and DHIC as the regulator, making it easier for healthcare providers to report more accurately for the care they deliver and ensuring speedier approval processes for patients.
“With over 10,000 codes available for services and procedures, the CPT codes will better capture the state of modern healthcare in Dubai. It will also enable Dubai’s medical community to support technology-enabled services in digital medicine and foster innovative and integrated care models for providing high-quality medical care.”
Hospitals set to adopt the CPT coding system are happy to have a streamlined system that will help them get quicker payments on insurance claims.
S.K. Rai, hospital director for Prime Hospital, told:
“In the previous system, many codes were missing or lacking. The new updated version will ensure greater clarity in payments and eliminate room for error. This will also help patients seeking insurance pre-approval for a surgery to get an idea of the total price involved and his or her copayment amount. Once there is no ambiguity, it will accelerate the process of pre-approval and also payment of claims we submit to insurance.”
According to Saleh Al Hashimi, CEO of Dubai Health Insurance Corporation (DHIC), the adoption of CPT would enhance the eClaimLink, Dubai’s centralised data exchange system that healthcare payers, providers and DHIC as regulator in Dubai use with modern clinical content.
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