Hi, everyone. This is Lukas Voss with Becker's
HealthCare. Thanks so much for joining us here
today for the Becker's HealthCare podcast series.
I'm really excited to have, 2 great guests
today to discuss the 2025
CPT changes and
their impacts. This is a very large topic
with a lot of different implications, so I'm
excited we get to talk about it.
And I have 2 guests, as I mentioned,
Elaine Dunn, chief administrative officer, Nimble Solutions, and
Jessica atmiston, SVP, coding Nimble Solutions. Elaine and
Jessica, thanks so much for joining us today.
Excited to have you. Yeah. Thank you, Lucas.
Excited to be here. Absolutely. And before we
get into it, I also wanna mention that
if you're listening to today's podcast,
the thing that you have to do, right,
you have to listen to the end. We
have a little bit of a surprise for
our our listeners here today, so make sure
that you listen all the way to the
end. Not just because we're gonna have a
great, conversation, of course, but also because we're
gonna have a little bit of a surprise
for you at the end here. Elaine and
Jessica, again, once again, welcome to the podcast.
If you could get us started here, we'll
start with you, Elaine. Share a little bit
about your experience and and your role at
Nimble.
Yeah. Sure. So I lead the Nimble's coding
service delivery team, our implementation
methodology,
and then also head up our discovery and
diligence processes for new clients and then have
responsibility
for our compliance and and regulatory
teams as well.
Just a little bit about, Nimble from a
background perspective.
We are a full service end to end
surgical revenue cycle management
company, and and our goal is to achieve
exceptional
financial results for our clients very specifically
in that outpatient surgical market.
Awesome. Jessica, we'll head over to you.
Great. Thank you. So I am a certified
ASC coder as well as the senior vice
president of coding at Nimble.
I'm responsible for implementing best coding practices,
deepening our coding team's expertise through continuing education,
and I collaborate closely with Nimble's performance review
team to ensure coding compliance and to optimize
revenue capture.
Awesome. And we have a a a quite
a bit to cover today, and it it
it can be very technical as you both
know.
It is a standardized
system we're talking about that always comes with
a lot of technical questions and a lot
of details,
and and the American Medical Association,
the EMA, recently announced
that the current procedural terminology or CPT as
it's commonly known,
for 2025,
the 25 to 25 code set is going
to be updated.
So before we get into some of that,
I I'd look just like you.
We'll we'll start with Alain just to go
over
what is the CPT code set to get
us started,
and and why is it so important
today? Elaine, again, we'll we'll start with you.
Yeah. So CPT codes are the uniform
data coding set for medical procedures
and services. As you mentioned, it is published
by the AMA,
and then they have an oversight function with
the CPT editorial
panel.
Basically, it codifies
complex procedures. So it's there's a standard reporting
mechanism
for health care agencies and payers. So we're
all identifying
the same procedure in the same way.
A little bit on on the CPT editorial
panel,
it's an independent body,
that gets convened by the AMA, and they
oversee all of the updates that are going
into CPT. And they have a a pretty
rigorous process,
that they do that to ensure that codes
are reflecting
just the evolving needs of our providers and
and to continue to deliver modern health care
in the United States.
You know, I think CPT decisions are so
important for providers,
to understand because as it is, the primary
mechanism for you to report your services,
reimbursement
then gets tied back to each of those
CPT codes.
So understanding fully the intent of a CPT
code,
any changes to that code, and how that
impacts how you report that code can have
a pretty significant impact on your reimbursement, your
net revenue.
Yeah. And I just wanted to really quickly
just ask a follow-up question that just out
out of interest.
If this didn't exist, Elaine, right, if we
didn't have this or
it it doesn't it it exists, but we
don't quite understand it, what impact would that
have
if if we didn't have this?
Yeah. So I think, the the short answer
would be probably chaos
in terms of claims,
both from a reporting standpoint
trying to get, correct payment. You know, if
you think about a really simple example like
a chest X-ray.
A chest x-ray has a specific CPT code
that gets assigned to that. If we didn't
have that code, could you imagine trying to
report and then adjudicate claims on
free taxes as chest x-ray, c x r,
cxdashray.
So codifying that system and fully understanding all
of the details behind the CPT code
really allows us to kinda streamline that process,
again, for payers, reporting agencies.
But I think when you think about CPT
as well, it's important that you drill down
a level that it's not just reading that
high level description.
There's, usually a significant amount of source guidance
and reference material that also gets published, managed
by AMA CPT
But, again, kind of provides a lot of
details about when it's appropriate to use that
CPT code and when it is not. So
it's just as important to understand that element
of CPT code versus just the the actual
code set itself.
Yeah. Again, it's it's
as as a standardized system, right, that's why
we're doing this so that everybody has a
system that we can follow and be able
to to make things more round, have a
have a an approach to it, not just
a a shot in the dark, essentially. Jessica,
I'd I'd like you to touch on this
as well and and talk a little bit
about the importance and and what the CPT
code set is from from your perspective, from
your unique perspective as well.
Yeah. So this is a bit of an
exciting time for the coding world,
when all the
the CPT updates are announced and revealed.
So for this year, we're looking at 420
CPT updates
that include 270
new codes, a 112 deleted codes, and then
38 revised codes. And many of those include,
updates to the general surgery section
that will impact surgical centers and ASCs.
Category 3 codes, which are temporary codes established
for new and emerging technologies to allow data
collection,
and they're not reimbursed by the way, account
for 30% of the new codes. So the
CPT code set continues to expand in new
areas of medicine with proprietary laboratory analysis assigned
to the largest proportion of new codes at
37%,
mostly for novel genetic testing.
And then key updates in the CPT 2025
code set include digital medicine,
augmented and artificial intelligence,
and general surgery.
I feel like that's the most interesting part
too is that this evolving
need to to add to the list, right,
to be able to say, okay. Now here
is something completely new. You mentioned AI. I
think that that's really the the key piece
too is it it's constantly evolving. There's new
technologies
on a on a monthly basis, so there's
really this need to evolve simply because
of the advancement within technology. If we were
just to stay with the status quo, I
don't think that that would go over very
well. Elaine, I I I suppose you you
see it the same way, and and and
what are what have you observed as some
of the more notable changes? I'm assuming it
it goes along the lines the same with
with, tech and and some of the AI
changes.
Yes. I I think, and you touched on
this is that, to me, one of the
most exciting updates is that this year, there
have been CPT codes,
around automated artificial
intelligence.
So looking at how do we classify those
AI medical services and procedures,
you know, whether those are assistive technology,
augmentative,
or autonomous technology.
You know, obviously, AI is a a very
big, topic in the medical world right now.
So
seeing CPT keep up with that and then
acknowledge that that is going to be an
important part of the health care ecosystem
moving forward. You know, they've gone and released
codes around
electrocardiogram
measurements,
medical chest, imaging,
image guided prostate biopsies,
all of those are gonna be included in
the the 2025
code set. And, again, I I I think
it's very promising that AMA and CPT is
acknowledging the impact
that AI is having on medical practice.
It can't be ignored. I think I'm I'm
glad that they're, that that that's part of
the process.
Again, if they were to ignore that or
if if it there was just a general,
yeah, just a general
idea of, like, hey. We're just gonna not
address that. I think, we would all be
in a different space.
It's I think it needs to be it
needs to be part of all of the
processes itself.
So what's interesting to me about this conversation
is the fact that this is a a
highly complex area
that not only is it complex from the
start,
but it's evolving.
Right? So I can't just I can't just
sit and say, okay. I learned this. I
know
the code piece to it. I understand it.
I'm done.
It's an evolving
piece that really needs attention on a regular
basis. And quite frankly, and I say this,
you know, having done a little bit of
research and obviously part of our conversation today,
I wouldn't wanna do this on my own.
Right? I wouldn't wanna be the sole sole
person responsible for this. I think that that's
a key piece.
Elaine, I want you to start off with
this.
Why do you need a partner to do
this correctly?
Why do you need a partner to be
able to do this where it actually benefits
an organization,
benefits revenue cycle management,
especially in the ASC space?
Yeah. I I think it's I think it's
twofold. So the first set, probably a little
bit of more of a macro level. A
lot of times, we'll see that
ASCs just get lumped in with outpatient
services and in turn, kinda standard outpatient coding
and billing rules get applied.
But in reality, there are some pretty significant
differences in how you report and receive optimal
reimbursement
in the ASC space.
Mhmm.
Also specific to CPT encoding,
it's not just getting the list of codes,
you know, come January 1, 2025.
As you mentioned, that's very much an iterative
process. So there is continually new guidelines,
references being released
to augment the instructions
of CPT.
So really keeping up on those is is
a Herculon task, and that's where having a
partner that's laser focused
on your business
and your delivery of care, that specialty,
is really important.
And then I think one of the things,
you know,
ASC market, you know, accurate transcription, coding, billing,
you know, it's really allowing ASCs, which a
lot of them function like small businesses,
small business owners
to maintain their cash flow and and really
drive overall financial health. I think that's where,
you know, nimble being in the market for
over 20 years, we've been trusted,
with our clients to manage over 10,000,000,000
in net collections.
And, again, we're very passionate about the ASC,
the surgical space, and and helping those business
owners drive to that peak financial health.
Yeah. Jessica, I'd like to you to touch
on this as well in terms of the
the partnership piece and and why that's so
so critical.
Yeah. I mean, you hit the nail on
the head. I am so thankful that I
have a team that I work with to
work through all these challenges and Mhmm. Updates
on, an annual basis. I can't imagine doing
it on my own.
But in addition, staffing shortages are a major
problem in health
care, and we're expecting to continue to see
a shortage moving forward. So we also advise
clients on ways they can move important and
necessary work they don't have expertise in, like
coding, to our experts at Nimble.
Since we provide expertise in every aspect of
the revenue cycle, we remain focused on providing
support to staff strap ASCs
by offering an end to end workflow,
starting at the front desk to handle physician
credentialing, patient demographic entry,
insurance verification,
prior authorizations,
scheduling, chart management,
transcription, and then, of course, coding and billing
to provide our clients with the most efficient
turnaround times in the industry. We do this
by streamlining revenue cycles starting with decreasing the
manual and administrative tasks so
our clients can focus on our patients. And
we get claims out the door faster so
they can ultimately get paid faster.
And that's the most important piece, I think,
is is that patient focus. Right? We don't
wanna necessarily get bogged down by all of
these processes, but we wanna focus on the
patient. I think that that's a that's a
key piece to it. Elaine and Jessica, thanks
so much for your insights today. I think
this was a very interesting conversation on a
on a very complex topic.
Yeah. Thank you. Yeah. Thanks for having us.
And I also wanna thank our podcast sponsor,
Nimble Solutions. And, again, I did mention in
the beginning, I did have a little bit
of a surprise. But, again, if you listen
to this and you felt like, man, this
is so
I really, want to encourage you all,
to join Nimble's 2025 coding update webinar on
December 17th. It will dive into a lot
of these things that we discussed today. It's
at 1 PM
CST, and it will have a lot more
detail on the challenges that we discussed today.
So you can go to nimble,
crmnimblesrcm.com/codingresources
and click on the 2025
CPT Code Changes Webinar
right there. And now you need to pay
attention to this. For a limited time, if
you enter the code 2025
CPT
updates,
you will
be able to attend that live webinar at
no charge. Again that website is nimblercm.com/codingcourses,
and you can click on the 2025
CPT code changes
webinar there. And then use your code 2025
CPT updates
to attend that live webinar at no charge.
You'll learn more about some of the things
that we discussed today. Again, Elaine and Jessica,
thanks so much for being here today. Really
enjoyed our conversation.
Thank you. Looking forward to all the attendees
on the webinar.
Yes. And make sure to tune in to
more podcasts from Becker's Healthcare by visiting our
podcast page at beckershospitalreview.com.