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Get ready for the new 3D printing Category III CPT codes: Part 2


In Part 1 of this blog series, we spoke about the new Category III CPT codes that will soon become available for the use of medical 3D printed anatomical models in the USA.

Today, we continue the conversation between Blackford’s Greg Kingston and our Head of Partnerships, Katie McKinley about the importance of patient data collection and what needs to be done to support the Category III CPT codes' transition into category 1 CPT codes.

Greg: Why is it so important that all users of 3D printed models collect data on patient benefit?

Katie: We cannot stress enough the significance of data collection in order to build evidence. This will greatly support progressing the CPT codes for using 3D printed anatomical models from level III to level I.

Healthcare payers are beginning to see that sufficient evidence for coverage can be compiled well before a Category I code is approved. Despite some initial resistance, this means that we are seeing Category III CPT codes increasingly being accepted by payers for coverage.

This shift in payer perspective has largely been driven by physicians’ willingness to embrace new technology with Category III codes. It is only through physicians’ continued advocacy of new technologies that the temporary code system will succeed in supporting the introduction of new technology that ultimately drives better outcomes for patients.

Greg: Do you have any advice for medical professionals about how best to collect data?

Katie: Where possible, it’s ideal to try and gather data on a small number of key applications. Hospitals typically use 3D printing for particular use cases, such as congenital cardiac planning, but sometimes they provide 3D printing for other complex cases. This can also include lots of one-off cases. If surgeons are requesting one-off cases, encourage them to consider using an anatomical model for similar cases in the future. It’s also important to understand why the model was requested, as this can help with rolling-out services to other surgeons in a department.

The data itself should be carefully stored. Not just to adhere to a quality management system and ensure a robust audit trail, but also to provide this data to the CMS to help build the case for medical 3D printing.

As the driver for CPT codes is to achieve reimbursement, it is vital that the total cost of delivering the service is accurately calculated, and to ensure all of the production steps of model creation are recorded. This includes records of hardware, materials and software used, the staff that undertook the work, and the time taken at each stage to process. It’s important to be as precise as possible, and not underestimate the time for small administrative tasks, as this can add significant time and cost to the overall process. Where possible this data should be collected automatically.

All this information will be collated by the CMS and used to drive the process for allocating a dollar amount for the CPT code.

Greg: And what about considerations for surgeons and radiologists?

Katie: It’s important that surgeons are clear on the need for feedback on the case outcome relating to the use of the model. The more quantitative data that can be gathered the better. It's also important to try to gather retrospective data for similar cases, if possible. This includes data such as changes in procedure plan, theater time, information about the theater equipment used and so on. But the soft benefits are also important, such as surgeon confidence and patient experience, for example.

And it’s essential to keep radiology involved throughout the process. It can be easy to fall into the trap of only including radiology at the segmentation phase; Focusing on the surgical teams after the model is created. Radiology will be the driver of CPT adoption, so it’s important to ensure any information relating to improved patient outcomes is fed back to the radiology team. They should also be aware of any key applications and trends around model requests. Ultimately, the goal is that the radiologist can make a recommendation or request for a 3D printed model based on differential diagnosis, or there are standardized protocols in place that make a 3D printed model essential in specific cases, based on those which see the greatest impact.

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