AMA billing codes are new target in D.C.’s. war on health care fraud

WASHINGTON — For decades, politicians have blamed the country’s biggest doctor lobby for some of the health care systems problems. Now it faces a new line of attack as Republicans portray their health care cuts as fraud-fighting policies. 

The law requires that doctors bill for services in Medicare and Medicaid using Current Procedural Terminology, or CPT, codes, which are owned by the American Medical Association. The codes describe what services a patient received.

A key House Republican is requesting a meeting with Centers for Medicare and Medicaid Services officials to discuss their oversight of the CPT coding system as part of his committee’s investigation into fraud, waste, and abuse. In the letter, Rep. James Comer (Ky.) suggests the “complexity” of medical coding “may be contributing to improper billing and higher costs” and “creates an environment where billing inaccuracies can flourish.”