Medicine:Current Procedural Terminology

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The Current Procedural Terminology (CPT) code set is a medical code set maintained by the American Medical Association through the CPT Editorial Panel.[1] 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.[2] The current version is the CPT 2020. It is available in both a standard edition and a professional edition.[3][4]

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.[5]

CPT is currently identified by the Centers for Medicare and Medicaid Services (CMS)[6] as Level 1 of the Healthcare Common Procedure Coding System.

The Current Procedural Terminology (CPT) was developed by the American Medical Association (AMA).[6]

Types of code

There are three types of CPT code: Category I, Category II, and Category III.

Category I

Category I CPT Code(s). There are six main sections:[7]

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[8]
  • (00800–00882) lower abdomen[9]
  • (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

  • (70010–76499) diagnostic radiology
  • (76500–76999) diagnostic ultrasound
  • (77001–77032) radiologic guidance
  • (77051–77059) breast mammography
  • (77071–77084) bone/joint studies
  • (77261–77999) radiation oncology
  • (78000–79999) nuclear medicine

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

Category II

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.[10]

Category III

  • Category III CPT Code(s) – Emerging technology (Category III codes: 0016T-0207T[11])

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.[12]

Criticism of copyright

CPT is a registered trademark of the American Medical Association, and its largest single source of income.[13] The AMA holds the copyright for the CPT coding system.[14] However, in Practice Management v. American Medical Association[15] 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.[16] 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[17] by a petition motivated by an Administrative Conference of the United States recommendation.[18]

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.[19]

Limited CPT search offered by the AMA

In the past, AMA offered a limited search of the CPT manual for personal, non-commercial use on its web site.[20]

History

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.[21] Procedural information was dropped in the transition from the SNDO to CMT, but was released separately as the Current Procedural Terminology in 1966.[22][23]

See also

References

  1. AMA (CPT) CPT Process
  2. 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. https://books.google.com/books?id=b9NyTDdaEEsCandpg=RA2-PA102. Retrieved 26 May 2011. 
  3. 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. https://books.google.com/books?id=vZv5RQAACAAJ. Retrieved 26 May 2011. 
  4. 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. https://books.google.com/books?id=-FP1RQAACAAJ. Retrieved 26 May 2011. 
  5. Alexander, Sherri, Pharm.D. (1 November 2003). "Overview of inpatient coding". American Journal of Health-System Pharmacy 60. Archived from the original on 17 September 2012. https://web.archive.org/web/20120917102527/https://www.ashp.org/s_ashp/docs/files/Suppl6_Alexander.pdf. Retrieved 30 April 2013. 
  6. 6.0 6.1 Centers for Medicare and Medicaid Services
  7. Marie A. Moisio (8 April 2009). Medical Terminology for Insurance and Coding. Cengage Learning. pp. 80–. ISBN 978-1-4283-0426-0. https://books.google.com/books?id=HjYEikV_n6MCandpg=PA80. Retrieved 26 May 2011. 
  8. "Anesthesia for Procedures on the Upper Abdomen". Archived from the original on 2016-10-05. https://web.archive.org/web/20161005122825/https://www.supercoder.com/cpt-codes-range/26. Retrieved 2016-10-04. , Anesthesia for procedures on the upper abdomen
  9. "Anesthesia for lower abdomen". https://www.supercoder.com/cpt-codes-range/30. ,Anesthesia for procedures on the lower abdomen
  10. AMA coding manual
  11. CPT 2010
  12. Centore, Anthony. "2013 CPT Code Revisions". Thriveworks.com. http://thriveworks.com/blog/2013-cpt-code-revisions-what-the-changes-mean-for-counselors/. Retrieved 6 February 2013. 
  13. Rosenthal, Elisabeth (2017-03-29). "Those Indecipherable Medical Bills? They're One Reason Health Care Costs So Much". The New York Times. https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html. 
  14. AMA (CPT) CPT Licensing
  15. "Practice Management Info. v. American Medical Ass'n, 121 F. 3d 516 - Court of Appeals, 9th Circuit 1997". Archived from the original on 2016-10-21. https://web.archive.org/web/20161021071020/https://cyber.harvard.edu/people/tfisher/IP/1997%20PMI%20Abridged.pdf. Retrieved 2016-10-20. 
  16. Pamela, Samuelson (2007). "Questioning Copyrights in Standards" (in en). Boston College Law Review 48 (1). https://lawdigitalcommons.bc.edu/bclr/vol48/iss1/8/. 
  17. Contreras, Jorge (2013-04-10) (in en). Technical Standards and Bioinformatics. BIOINFORMATICS LAW. 
  18. "Administrative Conference Recommendation 2011-5 Incorporation by Reference Adopted December 8, 2011". Administrative Conference of the United States. https://www.acus.gov/sites/default/files/Recommendation-2011-5-Incorporation-by-Reference.pdf. 
  19. "Archived copy". http://www.ama-assn.org/ama1/pub/upload/mm/37/2009-annual-report.pdf. 
  20. AMA (2012). "cpt® Code/Relative Value Search". Retrieved from "Archived copy". Archived from the original on 2016-03-26. https://web.archive.org/web/20160326031927/https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do. Retrieved 2011-07-06. .
  21. "AMA to Publish Handbook of Medical Terminology". Journal of the Mississippi State Medical Association: 16–17. April 1962. https://archive.org/details/7505622X1.nlm.nih.gov/page/n341. 
  22. Moriyama, IM; Loy, RM; Robb-Smith, AHT (2011). Rosenberg, HM; Hoyert, DL. eds. History of the statistical classification of diseases and causes of death. Hyattsville, MD: National Center for Health Statistics. p. 7. https://www.cdc.gov/nchs/data/misc/classification_diseases2011.pdf. 
  23. Borman, Karen R (2016). "Medical Coding in the United States: Introduction and Historical Overview". in Savarise, Mark; Senkowski, Christopher. Principles of Coding and Reimbursement for Surgeons. Springer. p. 4. ISBN 9783319435954. https://books.google.com/books?id=GXjQDQAAQBAJ&pg=PA4&lpg=PA4. 

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