Coding and Compliance Committee Member

Committee Member
Service as a committee member is a one-year appointment with potential for reappointment for up to two additional terms. Service requires participation on monthly conference calls and collaborative involvement on projects that meet the committee mandate. 

Mandate: The Coding and Compliance Committee evaluates changes related to new and existing CPT and HCPCS Level II codes, and code values as determined by the Relative Value Scale Update Committee [RUC] and Centers for Medicare and Medicaid Services (CMS) rules, policies and regulations to make recommendations to the Board of Directors.

Current Goals for 2021/2022:

1. Monitor changes to, or introduction of new, HCPCS Level II and CPT codes that are relevant to sleep medicine providers.
2. Identify opportunities for creating new codes for sleep medicine by reviewing all AASM clinical practice guidelines and the ICSD-3.
3. Evaluate requests to develop or support CPT code change proposals and/or partner with sister organizations to develop and submit code change proposals.
4. Review and assess recommendations relevant to sleep medicine providers in the CMS Proposed Physician Fee Schedule Rule.
5. Develop resources for members to educate them on how to correctly code for services and properly comply with national and regional Medicare policies and other federal rules and regulations (e.g., E/M office codes, Merit-based Incentive Payment System (MIPS)).
6. Update and maintain coding FAQs on AASM website, including developing FAQs for providers and centers which address how to handle discrepancies between the AASM hypopnea scoring criteria and CMS policy.
7. Respond to member inquiries specific to the areas of coding and reimbursement.
8. In collaboration with the Payer Policy Review Committee, review the PAP national coverage determination (240.4) and local coverage determination (L33718) to identify any issues that impede patient care or are inconsistent with current AASM guidance and provide a rationale for why the current criteria and/or language are problematic.