CPT – History, Usage, Structure, Guidelines (Chapter 2 in Healthcare Code Set
book) Outpatient/Ambulatory care (<24 hours) Procedure Codes
• All CPT codes are 5 digits
• Modifiers will be two characters
• Includes Surgical Packages/Bundles
• 5th character T – emerging technologies not quite yet a CPT code
• Published by the AMA – American Medical Association
• Began in 1966 by AMA and then in 1983, adopted by CMS as the standard for
physician and hospital service coding.
This expansive, important code set is published and maintained by
the American Medical Association (AMA).
CPT codes are used to describe tests, surgeries, evaluations, and any other
medical procedure performed by a healthcare provider on a patient. As you
might imagine, this code set is extremely large, and includes the codes for
thousands upon thousands of medical procedures.
CPT codes are an integral part of the billing process. CPT codes tell the
insurance payer what procedures the healthcare provider would like to be
reimbursed for. As such, CPT codes work in tandem with ICD codes to
create a full picture of the medical process for the payer. “This patient
arrived with these symptoms (as represented by the ICD code) and we
performed these procedures (represented by the CPT code).
Like ICD codes, CPT codes are also used to track important health data and
measure performance and efficiency. Government agencies can use CPT
codes to track the prevalence and value of certain procedures, and hospitals
may use CPT codes to evaluate the efficiency and abilities of individuals or
divisions within their facility.
FORMAT
Each CPT code is five characters long, and may be numeric or
alphanumeric, depending on which category the CPT code is in.
With CPT, ‘Category’ refers to the division of the code set. CPT codes are
divided into three Categories. Category I is the most common and widely
used set of codes within CPT. It describes most of the procedures performed
by healthcare providers in inpatient and outpatient offices and hospitals.
Category II codes are supplemental tracking codes used primarily for
, performance management. Category III codes are temporary codes that
describe emerging and experimental technologies, services, and
procedures.
Here’s a closer look at the three categories of CPT codes.
CATEGORY I
Like the ICD code set and its division into chapters by type of injury or
illness, Category I CPT codes are divided into six large sections based on
which field of health care they directly pertain to. The six sections of the
CPT codebook are, in order:
• Evaluation and Management
• Anesthesiology – bundled package codes, tied to surgery, includes
time factor
• Surgery – Largest section
• Radiology
• Pathology and Laboratory
• Medicine
CPT codes are, for the most part, grouped numerically. The codes for
surgery, for example, are 10021 through 69990.
In the CPT codebook, these codes are listed in mostly numerical order,
except for the codes for Evaluation and Management. These Evaluation and
Management, or E&M, codes are listed at the front of the codebook for ease
of access. Physician’s offices frequently use E&M codes for reporting a
number of their services. The code 99214, for a general checkup, is listed in
the E&M codes, for example.
Here’s a quick look at the sections of Category I CPT codes, as arranged by
their numerical range.
• Evaluation and Management: 99201 – 99499
• Anesthesia: 00100 – 01999; 99100 – 99140
• Surgery: 10021 – 69990
• Radiology: 70010 – 79999
• Pathology and Laboratory: 80047 – 89398
• Medicine: 90281 – 99199; 99500 – 99607
Within each of these code fields, there are subfields that correspond to how
that topic—say, Anesthesia—applies to a particular field of healthcare. For
book) Outpatient/Ambulatory care (<24 hours) Procedure Codes
• All CPT codes are 5 digits
• Modifiers will be two characters
• Includes Surgical Packages/Bundles
• 5th character T – emerging technologies not quite yet a CPT code
• Published by the AMA – American Medical Association
• Began in 1966 by AMA and then in 1983, adopted by CMS as the standard for
physician and hospital service coding.
This expansive, important code set is published and maintained by
the American Medical Association (AMA).
CPT codes are used to describe tests, surgeries, evaluations, and any other
medical procedure performed by a healthcare provider on a patient. As you
might imagine, this code set is extremely large, and includes the codes for
thousands upon thousands of medical procedures.
CPT codes are an integral part of the billing process. CPT codes tell the
insurance payer what procedures the healthcare provider would like to be
reimbursed for. As such, CPT codes work in tandem with ICD codes to
create a full picture of the medical process for the payer. “This patient
arrived with these symptoms (as represented by the ICD code) and we
performed these procedures (represented by the CPT code).
Like ICD codes, CPT codes are also used to track important health data and
measure performance and efficiency. Government agencies can use CPT
codes to track the prevalence and value of certain procedures, and hospitals
may use CPT codes to evaluate the efficiency and abilities of individuals or
divisions within their facility.
FORMAT
Each CPT code is five characters long, and may be numeric or
alphanumeric, depending on which category the CPT code is in.
With CPT, ‘Category’ refers to the division of the code set. CPT codes are
divided into three Categories. Category I is the most common and widely
used set of codes within CPT. It describes most of the procedures performed
by healthcare providers in inpatient and outpatient offices and hospitals.
Category II codes are supplemental tracking codes used primarily for
, performance management. Category III codes are temporary codes that
describe emerging and experimental technologies, services, and
procedures.
Here’s a closer look at the three categories of CPT codes.
CATEGORY I
Like the ICD code set and its division into chapters by type of injury or
illness, Category I CPT codes are divided into six large sections based on
which field of health care they directly pertain to. The six sections of the
CPT codebook are, in order:
• Evaluation and Management
• Anesthesiology – bundled package codes, tied to surgery, includes
time factor
• Surgery – Largest section
• Radiology
• Pathology and Laboratory
• Medicine
CPT codes are, for the most part, grouped numerically. The codes for
surgery, for example, are 10021 through 69990.
In the CPT codebook, these codes are listed in mostly numerical order,
except for the codes for Evaluation and Management. These Evaluation and
Management, or E&M, codes are listed at the front of the codebook for ease
of access. Physician’s offices frequently use E&M codes for reporting a
number of their services. The code 99214, for a general checkup, is listed in
the E&M codes, for example.
Here’s a quick look at the sections of Category I CPT codes, as arranged by
their numerical range.
• Evaluation and Management: 99201 – 99499
• Anesthesia: 00100 – 01999; 99100 – 99140
• Surgery: 10021 – 69990
• Radiology: 70010 – 79999
• Pathology and Laboratory: 80047 – 89398
• Medicine: 90281 – 99199; 99500 – 99607
Within each of these code fields, there are subfields that correspond to how
that topic—say, Anesthesia—applies to a particular field of healthcare. For
