Current Procedure Terminology (CPT®)

 

Current Procedure Terminology (CPT^®)

 CPT is Clinical Coding Nomenclature used to convert all Clinical procedures and services in to numeric or alpha numeric codes. CPT is Owned by American Medical Association and an internationally recognized procedure coding system. It’s an easy to use, yet complex, capable to connect with any software platforms and interface systems and widely accepted for clinical reimbursement from most of the insurance payers.

 CPT – The Background

 Current Procedural Terminology, more commonly known as CPT^®, refers to a set of medical codes used by physicians, allied health professionals, nonphysician practitioners, hospitals, outpatient facilities, and laboratories to describe the procedures and services they perform.

 Specifically, CPT^® codes are used to report procedures and services to federal and private payers for reimbursement of rendered healthcare.

 In 1966, the American Medical Association (AMA) created CPT^® codes to standardize reporting of medical, surgical, and diagnostic services and procedures performed in inpatient and outpatient settings. Each CPT^® code represents a written description of a procedure or service, eliminating the subjective interpretation of precisely what was provided to the patient. AMA updates the CPT^® code set annually, releasing new, revised, and deleted codes, as well as changes to CPT^® coding guidelines.

 Types of CPT^® Codes

AMA has organized CPT^® codes logically, beginning with classifying them into three types:

 ·   CPT^® Category I: The largest body of codes, consisting of those commonly used by providers to report their services and procedures

·   CPT^® Category II: Supplemental tracking codes used for performance management

·   CPT^® Category III: Temporary codes used to report emerging and experimental services and procedures

 

CPT^® even includes codes called unlisted codes for those services and procedures not specifically named in another defined CPT^® code.

 CPT^® Codes – Identification

Integral to billing medical services and procedures for reimbursement, CPT^® is the language spoken between providers and payers.

 CPT^® codes consist of five characters. The majority of codes are numeric, but some codes have a fifth alpha character, such as A, F, T, or U. Examples include:

 

33275	Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (e.g., fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed
0004A	Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted: booster dose
3006F	Chest X-ray results documented and reviewed (CAP)
0510T	Removal of sinus tarsi implant
0079U	Comparative DNA analysis using multiple selected single-nucleotide polymorphisms (SNPs), urine and buccal DNA, for specimen identity verification

 

 Category I Codes

Typically denoted by five numeric characters and arranged in numerical order. E/M codes start with the number 9, they are printed first in CPT^® code books. The AMA chose this order because E/M services are the most frequently reported healthcare services.

The 6 main sections of CPT^® Category I codes are:

1.      Evaluation & Management (99202 - 99499)

2.      Anesthesia (00100 - 01999)

3.      Surgery (10021- 69990) - further broken into smaller groups by body area or system within this code range

4.      Radiology Procedures (70010 - 79999)

5.      Pathology and Laboratory Procedures (80047- 89398)

6.      Medicine Services and Procedures (90281- 99607)

 Category II Codes

Category II codes, consisting of four numbers and the letter F, are supplemental tracking and performance measurement codes that providers can assign in addition to Category I codes. Unlike Category I codes, Category II codes are not linked to reimbursement.

 Providers use Category II codes which track specific information about their patients, such as whether they use tobacco, to help deliver better healthcare and achieve better outcomes for patients.

 You’ll typically find Category II codes directly after the Category I codes in your CPT® code book. These codes are arranged as follows:

 

1.      Composite Measures (0001F - 0015F)

2.      Patient Management (0500F - 0584F)

3.      Patient History (1000F - 1505F)

4.      Physical Examination (2000F - 2060F)

5.      Diagnostic/Screening Processes or Results (3006F - 3776F)

6.      Therapeutic, Preventive, or Other Interventions (4000F - 4563F)

7.      Follow-up or Other Outcomes (5005F - 5250F)

8.      Patient Safety (6005F - 6150F)

9.      Structural Measures (7010F - 7025F)

10. Nonmeasure Code Listing (9001F - 9007F)

  Category III Codes

Category III codes, depicted with four numbers and the letter T, and are temporary codes that represent new technologies, services, and procedures.

 Temporary codes describing new services and procedures can remain in Category III for up to five years. AMA releases new or revised Category III codes semiannually via their website but publishes the Category III deletions annually with the full set of temporary codes.

 CPT^® Coding Guidelines

The AMA provides CPT^® coding guidelines that detail when and how to assign codes, which codes can and can’t be reported together, and other factors critical to compliant coding.

 Modifiers in CPT^®

A CPT modifier consists of two numbers, two letters, or a number and a letter. Many situations require a coder to append modifiers to a CPT^® code to further describe the service or procedure provided. For example, some modifiers show that a procedure was performed on the right side of the body, versus the left side or both sides. Other modifiers indicate that a physician took extra time and effort to perform a service or procedure.

 These are examples of some of the most used CPT® modifiers:

25 - Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service

26 - Professional component

59 - Distinct procedural service

  Conclusion

CPT, a Highly recommended procedure classification system for billing and reimbursement.