CURRENT PROCEDURE TERMINOLOGY (CPT)

Current Procedural Terminology (CPT) is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations. CPT codes are used in conjunction with ICD-10-CM numerical diagnostic coding during the electronic medical billing process.

There are three types of CPT codes: Category 1, Category 2 and Category 3. The current version of the CPT codes is known as CPT 2018. CPT is a registered trademark of the American Medical Association (AMA).

There are approximately 7,800 CPT codes ranging from 00100 through 99499.  Two digit modifiers may be appended when appropriate to clarify or modify the description of the procedure.

It is published in two versions – the first is the most common, CPT Physician’s Current Procedural Terminology. A second publication is also available – the CPT Physician’s Current Procedural Terminology Specially Annotated for Hospitals. The Hospital version contains all the information in the original version with the addition of special Medicare guidelines and notations for identifying criteria applicable to outpatient hospital billing.

The rules for assigning the appropriate code are complex, and so we advise individuals who are determining the appropriate codes receive the proper training and credentials.  This would include any office or clinic personnel who play a significant role in coding.

Category 1: Procedures and contemporary medical practices

Category 1 covers procedures and contemporary medical practices that are widely performed. Category 1 is the sections coders usually identify with when talking about CPT and are five-digit numeric codes that identify a procedure or service that is approved by FDA, performed by healthcare professionals nationwide, and is proven and documented.

Category 1 codes are broken down into six sections:

•          Evaluation and management

•          Anesthesiology

•          Surgery

•          Radiology

•          Pathology and laboratory

•          Medicine

Category 2: Clinical Laboratory Services

The Category 2 CPT medical code set consists of the supplementary tracking codes that are used for performance measures and are intended to help collect information about the quality of care delivered. The use of this medical code set is optional and is not a substitute for Category 1 codes.

Category 3: Emerging technologies, services and procedures

The Category 3 CPT code list consists of temporary codes that cover emerging technologies, services and procedures. They differ from the Category 1 medical CPT codes list in that they identify services that may not be widely performed by healthcare professionals, may not have FDA approval, and also may not have proven clinical efficacy. To be eligible, the service or procedure must be involved in ongoing and planned research. The purpose of these CPT codes is to help researchers track emerging technologies and services.