Dr. Erkan Hassan

Monthly Writings

Evaluations and reviews of the latest in the field.

Artificial Intelligence Terminology to be Included with CPT Codes

SUMMARY:

  • AMA has published CPT code descriptors to be included in the Artificial Intelligence (AI) CPT code set

  • AI taxonomy for medical services and procedures are grouped as assistive; augmentative or Autonomous.

  • Submission of CPT codes should consistently use this taxonomy

REVIEW

Taxonomy of Artificial Intelligence for CPT Codes

  • As of 2022, the FDA has authorized 343 products as Software as a Medical Device (SaMD).

  • As AI continues to grow, healthcare providers need a framework to differentiate appropriate CPT codes.

  • The American Medical Association (AMA) has published the “Taxonomy of Artificial Intelligence For Medical Services and Procedures” intended to be included within the CPT code set.

  • The descriptors within the taxonomy are intended for healthcare providers (HCPs) to accurately characterize the work done by HCPs with the SaMD.

Intended Use of AI Taxonomy for CPT Codes

  • The descriptors may also be useful for SaMD products for valuation, coverage and payments to HCPs.

  • The intent is to use AI related CPT code descriptors consistently when an HCP submits a CPT code for an AI related code.

  • There is no definition of the term AI within the CPT code set as there is no single product, procedure or service that adequately describes the intended clinical use.

  • Rather, AI medical services are based on the clinical procedure or service provided to the patient and the role of the HCP.

  • The requestor should include the descriptor details necessary to support the appropriate CPT.

 

3 Categories of AI Taxonomy for Medical Services

  • Assistive Services:

    • Detect relevant clinical data

    • Does not reduce effort by clinician for analysis and interpretation

    • SaMD simply brings it to clinicians attention

    • May or may not impact diagnosis or management

  • Augmentative Services:

    • Provides clinically meaningful analyses and/or quantification of data

    • Does not provide interpretation or reporting

    • Clinician may perform additional analyses

    • Clinician interprets the output

  • Autonomous Services:

    • Includes interpretation and clinical conclusions

    • Independently reported

    • May lead to a recommendation or action

3 Levels of AI Taxonomy

There are 3 levels of the Autonomous AI Medical Serivces based on HCP involvmenet

CONCLUSIONS:

  • The use of AI CPT code set should include the above taxonomy consistently.

  • The descriptors should align the devices output, interaction between HCP and the device and appropriate payment.

  • Descriptors include “Assistive”, “Augmentative”; and “Autonomous”.

Erkan Hassan