CPT is the abbreviation of “Current procedural terminology.” The American Medical Association (AMA) presents and maintains the CPT coding system. It contains a set of standardized codes assigned to surgical, medical, and diagnostic services provided by healthcare professionals. The American Medical Association updates the codes every year following the changes in medical procedures, healthcare practices, and evolving technology. You will find detailed information about the CPT coding system in this article.
Structure of CPT coding system:
There are three main categories of the CPT coding system as follows:
Category I of the CPT coding system includes codes for surgeries, medical and diagnostic procedures. Medical services providers use these codes to document the procedures mentioned above. These documents, in the form of codes, are used to submit insurance claims. These codes are organized into six sections as follows:
1. Evaluation and Management:
This section includes codes for services provided by healthcare professionals, such as consultations, office visits, hospital visits and stays, and preventive medicine services to evaluate, diagnose and manage patients. E&M codes start from 99-series of CPT codes, i.e., 99213, 99214, etc
This section includes codes for anesthesia services, such as the type of anesthesia used, the patient’s physical status during the procedure, and the duration of anesthesia provided during surgical or diagnostic procedures. Anesthesia codes are unique that begin with the digit “zero.” For example, 00811, 00720, etc.
This section includes the codes assigned to major and minor surgical procedures. These codes describe the extent of the procedure, the surgical approach used, and any additional procedures provided.
Surgery CPT codes have no specific series to define. Example of surgery CPT code is 27445, 28045, etc.
This section contains the codes that describe the type of imaging, such as X-rays, computed tomography, magnetic resonance imaging, and ultrasound, the part being imaged, and the number of views taken.
Radiology CPT codes fall in the 70000 series. Example of radiology cpt codes is 73630, 76942, etc.
5. Pathology and Laboratory:
This section includes the codes assigned to the various laboratory tests and procedures, such as blood serum analysis, urine tests, and biopsies. As mentioned in the radiology section, these codes also describe the type of test performed, the part being analyzed, and the method used to perform the test. Pathology and Laboratory CPT Code range between 80047- 89398.
This section contains the codes for vaccinations, chemotherapy, infusion therapy, and services not included in the other CPT code sections. An example is 90672.
Category II of the CPT coding system includes the optional codes that are not usually used for billing purposes but instead used to collect data on the quality of health services provided, such as patient safety, public health, and care coordination.
Category II codes are organized into the following sections with their own set of codes each:
1. Patient Management:
This section includes the codes that are related to patient care management, including medication, patient education, and care transitions.
2. Preventive Care:
This section includes the codes describing preventive care services such as immunization, screening, and chronic disease management.
3. Performance Measurement:
This section contains the codes that are related to measuring health quality, patient safety, community health, and care coordination.
This section contains codes related to information about administrative tasks such as processing claims and billing them.
As Category I codes, these codes are also updated yearly according to the changes in healthcare quality requirements. These codes are optional ones to be used in conjunction with the Category I codes for a comprehensive view. Although not used in billing processes, the data collected using these codes can be used by government agencies, healthcare organizations, and policymakers while making policies about healthcare.
This temporary section includes the codes assigned to emerging technologies, services, and procedures that have yet to be widely used or established. These codes help track and report the new and emerging technologies in healthcare services. Like Category II codes, these codes are also not used in the billing and reimbursement process. Instead, they help in research and policymaking in the healthcare system. The categorization of codes in different sections is as follows:
1. Medical and Surgical:
New and emerging medical and surgical procedures such as laser ablation, robotic-assisted surgery, joint distraction, and many other procedures can be coded under this section.
2. Ancillary Services:
This section codes new emerging diagnostic and laboratory testing services and technologies.
3. Emerging Technology:
This section includes codes that carry information about emerging technologies, such as gene therapy and virtual reality therapy.
4. Other Services:
Codes in this section describe other services, such as telemedicine and care coordination, that are not present or described in the above sections.
Each category has a different purpose and structure for its codes.
Category I codes are the most commonly used. These five-digit codes represent medical procedures, services, and treatments according to the abovementioned six sections.
Category II codes are alphanumerical, having four digits beginning with the letter “F.” They are also organized into several sections, as previously mentioned.
Category III codes are five-digit codes that begin with the letter T and are organized into several sections, each having its own set of codes.
Importance of CPT coding system:
Healthcare providers, insurers, and policymakers widely use the CPT coding system as it is a vital tool to document medical services provided to policyholders to submit claims for reimbursement purposes. It facilitates an accurate and efficient billing process in the healthcare system, improving the overall quality of the services and patient safety.
1. Important for medical billing:
CPT coding system makes medical billing an accurate and efficient process. This system allows healthcare providers to quickly document the services they provide using the separate codes assigned to each service and submit claims to insurance companies for reimbursement. This process allows providers to get a refund for their services.
2. Tracking and reporting the medical procedure and treatments:
Healthcare providers can improve healthcare quality and patient safety by keeping records of the healthcare services they provide in coded form while considering new trends in healthcare delivery and utilization as well as policymaking and addressing any issues in providing quality healthcare.
3. Research and policy making:
CPT coding system helps in documenting and reporting valuable data and estimating the health cost and utilization. The researchers and policymakers use this data to identify new trends and monitor the effectiveness of new and ongoing treatments and technologies. Evidence-based policymaking is essential to improve healthcare quality and access to ever-changing trends in the healthcare system.
4. Establishing guidelines:
The Centers for Medicare and Medicaid Services (CMS) and other regulatory bodies use the CPT coding system to establish healthcare billing and reimbursement guidelines. Healthcare providers follow these guidelines to ensure compliance with healthcare regulations and standards and supply high-quality care to patients.
Websites that provide information about the CPT coding system:
Learning about the CPT coding system is essential for medical billing and reimbursement processes and quality healthcare supply. Following are the websites that provide information about the CPT coding system:
1. American Medical Association (AMA):
As previously mentioned, the American Medical Association presents and maintains the CPT codes. This website provides information about the CPT coding system’s history, development, and guidelines. It teaches how to use and apply the codes and offers certification to medical coders.
2. Centers for Medicare and Medicaid Services (CMS):
Administrating the Medicare and Medicaid programs is the responsibility of the CMS. Their official website provides information on Medicaid billing, the use of the CPT coding system in billing, and how to bill specific services and procedures with the help of CPT codes.
3. American Academy of Professional Coders (AAPC):
It is an organization that provides information on using and applying CPT codes. It provides training and certificate programs to medical coders and billers.
Supercoders provides medical coding and billing resources and offers a variety of tools, including access to CPT, ICD 10, and HCPCS code sets. It also includes coding guides, newsletters, webinars, training courses, and a coding forum where users can ask questions and share information with healthcare professionals.
This website helps coders by providing specific search tools for different codes. It also provides tools for cross-referencing codes with other code sets and information about medical coding resources and the overall CPT coding system.
Description of CPT Codes
CPT Codes FAQ
What does CPT stand for?
CPT stands for Current procedural terminology.
Who maintains and assign CPT codes?
American Medical Association (AMA).
What codes are used in medical coding?
ICD-10-CM, ICD-10 PCS, CPT codes, HCPCS codes.
What is Medical Revenue Service?
American Medical Association (AMA)
Centers for Medicare and Medicaid Services (CMS)
American Academy of Professional Coders (AAPC)