Conversion Factor. A numerical figure, determined by the Health Care Financing Administration, that is multiplied by the total rvu for a service to determine its reimbursement amount. As of January 1, 1998, there is a single conversion factor for all medical specialites: $36.6873.
Correct Coding Initiative. A program run by the Health Care Financing Administration to monitor the coding practices of providers under Medicare. In the past, many physicians routinely misused the CPT coding system to obtain multiple payments for a single procedure. For example, amputation of the left foot would have been incorrectly coded as amputation of each of the left toes as well as the foot, resulting in much larger reimbursements. The government now runs sophisticated computer programs that analyze coding patterns and report on questionable billing practices, and with the monies saved in finding fraud, the government funds a large staff of thorough auditors who will report and prosecute fraud whether intentional or not.
Counseling. In CPT '98, counseling is defined as a discussion with a patient and/or family concerning medical information, such as diagnosis, test results, prognosis, treatment risks and benefits, treatment instructions and risks of noncompliance, and education. Counseling is an E/M service, and must be distinguished from psychotherapy, which refers to specific treatment procedures coded in the 908XX series (AMA, 1998).
Family History. For the purposes of CPT, family history is a review of medical events in the patient's family, including parents' and siblings' morbidity and mortality, especially as related to the presenting concerns or risk of morbidity (AMA, 1998).
Past History. A review of the patient's prior experiences with illnesses, injuries, and treatments, including hospitalizations, medications, allergies, surgeries, etc. Current medications, immunizations, and feeding/nutritional information are included in this category (AMA, 1998).
Practice Expense. An estimation, by the Health Care Financing Administration, of the costs of providing a medical service to a patient under Medicare. Practice expense is divided into both DIRECT and INDIRECT costs. Direct costs include materials consumed (tissues, play materials, crayons, photocopies, paper, pens, etc.), and personnel time (nursing, billing, reception, etc.) Indirect costs include commodities such as rent, utilities, advertising, etc., that are not procedure-specific but factor into a provider's expenses (Department of Health & Human Services, 1997).
Physicians' Current Procedural Terminology (CPT). A systematic listing and coding of procedures and services performed by physicians and other clinicians that is widely used for coding in billing and payment. The CPT listing, developed over decades by the American Medical Association, assigns a unique code to each medical procedure, with modifiers to refine the descriptions of the services provided.
Relative Value Unit (RVU). A unit of measure designed to permit comparison of the amounts of resources required to perform various provider services by assigning weight to such factors as personnel time, level of skill, stress level, and sophistication of equipment required to render a service. The Health Care Financing Administration requires that the three major components of a service or procedure provided under Medicare have RVUs assigned to them: physician work, practice expense, and malpractice expense (JCAHO, 1994).
Resource-Based Relative Value (RBRV). The actual figure or value arrived at in relative, nonmonetary work units (rvu's) that can later be converted into dollar amounts as a means for determining reimbursement for services. The formula for RBRV for a given service is: RVRB = (TW) (1 + RPC) (1 + AST), in which TW = total work by the provider; PRC = an index of relative specialty practice cost; and AST is an index of amortized value for the opportunity cost of specialized training. Total work input is defined by four attributes: time, mental effort and judgment, technical skill and physical effort, and psychological stress (JCAHO, 1994).
Resource-Based Relative-Value Scale (RBRVS). A method of reimbursement under Medicare that attempts to base reimbursements on the amount of resources, including cognitive and evaluative skils, required to diagnose and treat a patient's condition. The approach weighs the resources, including practice expenses and total work input, that go into the "manufacture" of a service or procedure (JCAHO, 1994).
Social History. A review of the patient's past and current activities and circumstances, including marital status; employment/education; sexual history; financial status; and patterns of use of drugs, alcohol, and tobacco (AMA, 1998).
System Review (or Review of Systems). An inventory of body systems obtained through a series of questions seeking to identify the patient's current and/or prior signs and/or symptoms (AMA, 1998). (See the AACAP 1997-98 CPT Training Module for detailed information on system review.)
Additional Information
American Medical Association (1998). cpt '98: Physicians' Current Procedural Terminology, Standard Edition. Chicago: AMA.
Department of Health & Human Services (1997). 42 CFR Part 400, et al. Part III. Federal Register, October 31, 1997.
Joint Commission on Accreditation of Healthcare Organizations (1994). Lexikon: Dictionary of Health Care Terms, Organizations, and Acronyms for the Era of Reform. Oakbrook, IL: JCAHO.
Click here for the CPT Codes.
57th Annual Meeting
October 26-31, 2010
New York, NY
Hilton New York
Call for Papers
The submission deadline for AACAP's Annual Meeting Call for Papers is Tuesday, February 16, 2010 or Tuesday, June 15, 2010 for late New Research Posters. All submissions must be made online. Click here for complete details and to start a submission.
Preliminary Schedule
The Annual Meeting Preliminary Schedule will be available online on June 15, 2010. The Registration Magazine with full program details will be mailed to all members in August. If you would like to be added to this mailing list, please contact Nelson Tejada at ntejada@aacap.org.
Registration
Registration for the Annual Meeting will open in August.
Hotel Reservations
The host hotels for AACAP's 57th Annual Meeting are the Hilton New York and Sheraton New York Hotel and Towers. The room block is not open to make reservations for the Annual Meeting and rates have not been confirmed. Check back in February for more information.
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Exhibit and Advertising Opportunities
Interested in exhibiting or advertising at AACAP's Annual Meeting? If so, contact Lindsay Schlauch at 202.966.7300, ext. 104 or lschlauch@aacap.org.
