Pacemaker

American Medical Association, Current Procedural Terminology (CPT()
Coding Change Request Form

← Category I CPT Code(s)

← Category III CPT Code(s) – Emerging Technology

|This form plays a vital role in maintaining and increasing the efficiency of the CPT process. It can be used to submit a coding |
|change request for any one of the three categories of CPT codes. As you fillout the form please consider which category of code |
|change you are requesting. For more information on the three categories please see the attached instructions. |
|Please complete this entire form (insert additional lines and pages as needed). Refer to the accompanying instructions if necessary |
|Once the application is completed, submit the requestelectronically via diskette, CD or e-mail to ccpsubmit@ama-assn.org |
|Date: |July 10, 2007 |
|Change requested by: | |
|Name: |Jim Collins, CPC-CARDIO, CHCC, ACS-CA |
|Organization: |The Cardiology Coalition |
|Address: |517 Broadway, Suite 201 |
|City, State, ZIP: ||
| |Saratoga Springs, NY 12866 |
|Telephone: |704-845-5142 |
|Fax:|n/a |
|E-mail: |Jim@CardiologyCoalition.com |
| |Please attach this cover sheet to your proposal. ||Does the procedure/service involve the use of a drug, vaccine product* or device that requires approval from the Food and Drug |
|Administration (FDA)? |
|( Yes (go to 2.)|
|( No (go to 3.) This is a requested change to CPT instructions and parenthetical notes. |
| |
|*Applications requesting establishment of CPT codes for vaccine products will not be considered untilevidence substantiating |
|completion of Phase III Clinical Trials and review of unblinded data is submitted to AMA. However, coding applications may be |
|considered prior to submission of the Biologic License Application (BLA) to the FDA. |
||
|If approval is necessary, has FDA approval been received for the device or drugs for the specific use that you are proposing? |
|( Yes, FDA has approved all necessary aspects of the service. |
|( No, some necessary element of the service has not received FDA approval....