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.
New editions are released each October. The current version is the CPT 2018. It is available in both a standard edition and a professional edition.
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.
The Current Procedural Terminology (CPT) was developed by the American Medical Association (AMA).
Types of code
There are three types of CPT code: Category I, Category II, and Category III.
Category I CPT Code(s). There are six main sections:
Codes for evaluation and management: 99201–99499
Codes for anesthesia: 00100–01999; 99100–99150
Codes for surgery: 10000–69990
Codes for Radiology: 70000-79999
Codes for pathology and laboratory: 80000–89398
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-0575F) Patient management
- (1000F-1220F) Patient history
- (2000F-2050F) Physical examination
- (3006F-3573F) Diagnostic/screening processes or results
- (4000F-4306F) Therapeutic, preventive or other interventions
- (5005F-5100F) Follow-up or other outcomes
- (6005F-6045F) Patient safety
- (7010F-7025F) Structural Measures
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.
- Category III CPT Code(s) – Emerging technology (Category III codes: 0016T-0207T)
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:
90801 –> \ Family therapy codes (90847 and 90846) will remain unchanged, as will codes for psychological testing.
Criticism of copyright
CPT is a registered trademark of the American Medical Association. 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 the AMA could not enjoin a competitor on the basis that the AMA had misused its copyright.
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.
Limited CPT search offered by the AMA
The AMA offers a limited search of the CPT manual for personal, non-commercial use on its web site.
- ^AMA (CPT) CPT ProcessArchived May 11, 2016, at the Wayback Machine.
- ^Laura Southard Durham (1 June 2008). Lippincott Williams and Wilkins' Administrative Medical Assisting. Lippincott Williams and Wilkins. pp. 2–. ISBN 978-0-7817-9789-4. Retrieved 26 May 2011.
- ^Michelle Abraham; Jay T. Ahlman; Angela J. Boudreau; Judy L. Connelly; Desiree D. Evans; Rejina L Glenn (30 October 2010). CPT 2011 Standard Edition. American Medical Association Press. ISBN 978-1-60359-216-1. Retrieved 26 May 2011.
- ^American Medical Association; American Medical Association (COR); Michelle Abraham; Jay T. Ahlman; Angela J. Boudreau; Judy L. Connelly (30 October 2010). CPT 2011 Professional Edition. American Medical Association Press. ISBN 978-1-60359-217-8. Retrieved 26 May 2011.
- ^Alexander, Sherri, Pharm.D. (1 November 2003). "Overview of inpatient coding"(PDF). American Journal of Health-System Pharmacy. 60. Archived from the original(PDF) on 17 September 2012. Retrieved 30 April 2013.
- ^ abCenters for Medicare and Medicaid ServicesArchived July 20, 2015, at the Wayback Machine.
- ^Marie A. Moisio (8 April 2009). Medical Terminology for Insurance and Coding. Cengage Learning. pp. 80–. ISBN 978-1-4283-0426-0. Retrieved 26 May 2011.
- ^"Archived copy". Archived from the original on 2016-10-05. Retrieved 2016-10-04. , Anesthesia for procedures on the upper abdomen
- ^AMA coding manual
- ^CPT 2010
- ^Centore, Anthony. "2013 CPT Code Revisions". Thriveworks.com. Retrieved 6 February 2013.
- ^AMA (CPT) CPT LicensingArchived October 21, 2016, at the Wayback Machine.
- ^"Archived copy"(PDF). Archived(PDF) from the original on 2016-10-21. Retrieved 2016-10-20.
- ^http://www.ama-assn.org/ama1/pub/upload/mm/37/2009-annual-report.pdf[dead link]
- ^AMA (2012). "cpt® Code/Relative Value Search". Retrieved from "Archived copy". Archived from the original on 2016-03-26. Retrieved 2011-07-06. .
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