Current Procedural Terminology
The Current Procedural Terminology (CPT) code set is a medical code set maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set (copyright protected by the AMA) describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.
CPT coding is similar to ICD-9 and ICD-10 coding, except that it identifies the services rendered, rather than the diagnosis on the claim (ICD-10-CM was created for diagnostic coding- it took the place of Volume 3 of the ICD-9). The ICD code sets also contain procedure codes (ICD-10-PCS codes), but these are only used in the inpatient setting.
CPT is currently identified by the Centers for Medicare and Medicaid Services (CMS) as Level 1 of the Healthcare Common Procedure Coding System.
Types of code
There are three types of CPT code: Category I, Category II, and Category III.
Codes for evaluation and management: 99201–99499
- (99201–99215) Office/other outpatient services
- (99217–99220) Hospital observation services
- (99221–99239) Hospital inpatient services
- (99241–99255) Consultations
- (99281–99288) Emergency department services
- (99291–99292) Critical care services
- (99304–99318) Nursing facility services
- (99324–99337) Domiciliary, rest home (boarding home) or custodial care services
- (99339–99340) Domiciliary, rest home (assisted living facility), or home care plan oversight services
- (99341–99350) Home health services
- (99354–99360) Prolonged services
- (99363–99368) Case management services
- (99374–99380) Care plan oversight services
- (99381–99429) Preventive medicine services
- (99441–99444) Non-face-to-face physician services
- (99450–99456) Special evaluation and management services
- (99460–99465) Newborn care services
- (99466–99480) Inpatient neonatal intensive, and pediatric/neonatal critical, care services
- (99487–99489) Complex chronic care coordination services
- (99495–99496) Transitional care management services
- (99499) Other evaluation and management services
Codes for anesthesia: 00100–01999; 99100–99150
- (00100–00222) head
- (00300–00352) neck
- (00400–00474) thorax
- (00500–00580) intrathoracic
- (00600–00670) spine and spinal cord
- (00700–00797) upper abdomen
- (00800–00882) lower abdomen
- (00902–00952) perineum
- (01112–01190) pelvis (except hip)
- (01200–01274) upper leg (except knee)
- (01320–01444) knee and popliteal area
- (01462–01522) lower leg (below knee)
- (01610–01682) shoulder and axillary
- (01710–01782) upper arm and elbow
- (01810–01860) forearm, wrist and hand
- (01916–01936) radiological procedures
- (01951–01953) burn excisions or debridement
- (01958–01969) obstetric
- (01990–01999) other procedures
- (99100–99140) qualifying circumstances for anesthesia
- (99143–99150) moderate (conscious) sedation
Codes for surgery: 10000–69990
- (10000–10022) general
- (10040–19499) integumentary system
- (20000–29999) musculoskeletal system
- (30000–32999) respiratory system
- (33010–37799) cardiovascular system
- (38100–38999) hemic and lymphatic systems
- (39000–39599) mediastinum and diaphragm
- (40490–49999) digestive system
- (50010–53899) urinary system
- (54000–55899) male genital system
- (55920–55980) reproductive system and intersex
- (56405–58999) female genital system
- (59000–59899) maternity care and delivery
- (60000–60699) endocrine system
- (61000–64999) nervous system
- (65091–68899) eye and ocular adnexa
- (69000–69979) auditory system
Codes for radiology: 70000–79999
Codes for pathology and laboratory: 80000–89398
- (80000–80076) organ or disease-oriented panels
- (80100–80103) drug testing
- (80150–80299) therapeutic drug assays
- (80400–80440) evocative/suppression testing
- (80500–80502) consultations (clinical pathology)
- (81000–81099) urinalysis
- (82000–84999) chemistry
- (85002–85999) hematology and coagulation
- (86000–86849) immunology
- (86850–86999) transfusion medicine
- (87001–87999) microbiology
- (88000–88099) anatomic pathology (postmortem)
- (88104–88199) cytopathology
- (88230–88299) cytogenetic studies
- (88300–88399) surgical pathology
- (88720–88741) in vivo (transcutaneous) lab procedures
- (89049–89240) other procedures
- (89250–89398) reproductive medicine procedures
Codes for medicine: 90281–99099; 99151–99199; 99500–99607
- (90281–90399) immune globulins, serum or recombinant prods
- (90465–90474) immunization administration for vaccines/toxoids
- (90476–90749) vaccines, toxoids
- (90801–90899) psychiatry
- (90901–90911) biofeedback
- (90935–90999) dialysis
- (91000–91299) gastroenterology
- (92002–92499) ophthalmology
- (92502–92700) special otorhinolaryngologic services
- (92950–93799) cardiovascular
- (93875–93990) noninvasive vascular diagnostic studies
- (94002–94799) pulmonary
- (95004–95199) allergy and clinical immunology
- (95250–95251) endocrinology
- (95803–96020) neurology and neuromuscular procedures
- (96101–96125) central nervous system assessments/tests (neuro-cognitive, mental status, speech testing)
- (96150–96155) health and behavior assessment/intervention
- (96360–96549) hydration, therapeutic, prophylactic, diagnostic injections and infusions, and chemotherapy and other highly complex drug or highly complex biologic agent administration
- (96567–96571) photodynamic therapy
- (96900–96999) special dermatological procedures
- (97001–97799) physical medicine and rehabilitation
- (97802–97804) medical nutrition therapy
- (97810–97814) acupuncture
- (98925–98929) osteopathic manipulative treatment
- (98940–98943) chiropractic manipulative treatment
- (98960–98962) education and training for patient self-management
- (98966–98969) non-face-to-face nonphysician services
- (99000–99091) special services, procedures and reports
- (99170–99199) other services and procedures
- (99500–99602) home health procedures/services
- (99605–99607) medication therapy management services
CPT II codes describe clinical components usually included in evaluation and management or clinical services and are not associated with any relative value. Category II codes are reviewed by the Performance Measures Advisory Group (PMAG), an advisory body to the CPT Editorial Panel and the CPT/HCPAC Advisory Committee. The PMAG is composed of performance measurement experts representing the Agency for Healthcare Research and Quality (AHRQ), the American Medical Association (AMA), the Centers for Medicare and Medicaid Services (CMS), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA) and the Physician Consortium for Performance Improvement. The PMAG may seek additional expertise and/or input from other national health care organizations, as necessary, for the development of Category II codes. These may include national medical specialty societies, other national health care professional associations, accrediting bodies and federal regulatory agencies.
Category II codes make use of an alphabetical character as the 5th character in the string (i.e., 4 digits followed by the letter F). These digits are not intended to reflect the placement of the code in the regular (Category I) part of the CPT codebook. Appendix H in CPT section contains information about performance measurement exclusion of modifiers, measures, and the measures' source(s). Currently there are 11 Category II codes. They are:
- (0001F–0015F) Composite measures
- (0500F–0584F) Patient management
- (1000F–1505F) Patient history
- (2000F–2060F) Physical examination
- (3006F–3776F) Diagnostic/screening processes or results
- (4000F–4563F) Therapeutic, preventive or other interventions
- (5005F–5250F) Follow-up or other outcomes
- (6005F–6150F) Patient safety
- (7010F–7025F) Structural measures
- (9001F–9007F) Non-measure claims-based reporting
CPT II codes are billed in the procedure code field, just as CPT Category I codes are billed. Because CPT II codes are not associated with any relative value, they are billed with a $0.00 billable charge amount.
Major psychotherapy revisions
The CPT code revisions that affect counselors are simple and straightforward. Here is a list of psychotherapy CPT codes that will be retired, and their 2013 comparables:
Criticism of copyright
CPT is a registered trademark of the American Medical Association, and its largest single source of income. The AMA holds the copyright for the CPT coding system. However, in Practice Management v. American Medical Association the U.S. Court of Appeals for the Ninth Circuit held that while the AMA owned the copyright, it could not enjoin a competitor on the basis that the AMA had misused its copyright. Practice Management had argued that the publication of the CPT into federal regulation invalidated the copyright; the general debate around copyright and regulation access was revived in 2012 by a petition motivated by an Administrative Conference of the United States recommendation.
Despite the copyrighted nature of the CPT code sets, the use of the code is mandated by almost all health insurance payment and information systems, including the Centers for Medicare and Medicaid Services (CMS) and HIPAA, and the data for the code sets appears in the Federal Register. As a result, it is necessary for most users of the CPT code (principally providers of services) to pay license fees for access to the code.
As the AMA decided in April 1960, the Current Medical Terminology (CMT) handbook was first published in June 1962 – 1963 to standardize terminology of the Standard Nomenclature of Diseases and Operations (SNDO) and International Classification of Diseases (ICD), and for the analysis of patient records, and was aided by an IBM computer. Procedural information was dropped in the transition from the SNDO to CMT, but was released separately as the Current Procedural Terminology in 1966.
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