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Commentary |

The Undervaluation of Evaluation and Management Professional ServicesCurrent Procedural Terminology Deficiency Impact: The Lasting Impact of Current Procedural Terminology Code Deficiencies on Physician Payment

Erik A. Kumetz, MA; John D. Goodson, MD
Author and Funding Information

From the University of Miami Miller School of Medicine (Mr Kumetz), Miami, FL; and General Internal Medicine Unit, Department of Medicine and John D. Stoeckle Center for Primary Care Innovation (Dr Goodson), Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Correspondence to: John D. Goodson, MD, Massachusetts General Hospital, 15 Parkman St, Boston, MA 02114; e-mail: JGoodson1@Partners.org


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(3):740-745. doi:10.1378/chest.13-0381
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The Resource-Based Relative Value Scale (RBRVS) is fundamentally undermined by the following foundational errors: (1) The full range of office-based evaluation and management (E/M) activities are not captured by the Current Procedural Terminology (CPT) code choices, (2) it places relatively high values on procedural services, (3) there is no measure of intensity for complex outpatient E/M care, and (4) its maintenance and update have been delegated to select professional societies. Limitations imposed on the development of the RBRVS dating back to the early 1980s have not been corrected. The repertoire of codes for physician office-based E/M work must be expanded to create a new topology of choices with new outpatient code families with discrete service code levels, such as comprehensive outpatient consultation care, comprehensive outpatient primary care, and limited outpatient consultation care. Service code relative values must be based on representative samples and reliable survey data, draw from the broader literature on work intensity, and be developed with accountable and representative professional engagement.


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