- Current Procedural Terminology
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The Current Procedural Terminology (CPT) code set is maintained by the American Medical Association through the CPT Editorial Panel.[1] The CPT code set 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 2011. 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.
CPT is currently identified by the Centers for Medicare and Medicaid Services (CMS) [5] as Level 1 of the Health Care Procedure Coding System.
Contents
Types of codes
There are three types of CPT codes: Category I, Category II, and Category III.
Category I
Category I CPT Code(s). There are six main sections:[6]
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 dept 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 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 & management services
- (99460 - 99465) newborn care services
- (99466 - 99480) inpatient neonatal intensive, and pediatric/neonatal critical, care services
Codes for Anaesthesia: 00100-01999; 99100-99150
- (00100 - 00222) head
- (00300 - 00352) neck
- (00400 - 00474) thorax
- (00500 - 00580) intrathoracic
- (00600 - 00670) spine & 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 & popliteal area
- (01462 - 01522) lower leg (below knee)
- (01610 - 01682) shoulder & axilla
- (01710 - 01782) upper arm & elbow
- (01810 - 01860) forearm, wrist & hand
- (01916 - 01936) radiological procedures
- (01951 - 01953) burn excisions or debridement
- (01958 - 01969) obstetric
- (01990 - 01999) other procedures
Codes for Surgery: 10021-69990
- (10021 - 10022) general
- (10040 - 19499) integumentary system
- (20000 - 29999) musculoskeletal system
- (30000 - 32999) respiratory system
- (33010 - 37799) cardiovascular system
- (38100 - 38999) hemic & lymphatic systems
- (39000 - 39599) mediastinum & diaphragm
- (40490 - 49999) digestive system
- (50010 - 53899) urinary system
- (54000 - 55899) male genital system
- (55920 - 55980) reproductive system & intersex
- (56405 - 58999) female genital system
- (59000 - 59899) maternity care & delivery
- (60000 - 60699) endocrine system
- (61000 - 64999) nervous system
- (65091 - 68899) eye & ocular adnexa
- (69000 - 69979) auditory system
Codes for Radiology: 70010-79999
- (70010 - 76499) diagnostic imaging
- (76506 - 76999) diagnostic ultrasound
- (77001 - 77032) radiologic guidance
- (77051 - 77059) breast mammography
- (77071 - 77084) bone/joint studies
- (77261 - 77799) radiation oncology
- (78000 - 79999) nuclear medicine
Codes for Pathology & Laboratory: 80047-89398
- (80047 - 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 & 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: 90281-99189; 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 & clinical immunology
- (95250 - 95251) endocrinology
- (95803 - 96020) neurology & neuromuscular procedures
- (96101 - 96125) central nervous system assessments/tests (neuro-cognitive, mental status, speech testing)
- (96150 - 96155) health & behavior assessment/intervention
- (96360 - 96549) hydration, therapeutic, prophylactic, diagnostic injections & infusions, and chemotherapy & other highly complex drug or highly complex biologic agent administration
- (96567 - 96571) photodynamic therapy
- (96900 - 96999) special dermatological procedures
- (97001 - 97799) physical medicine & rehabilitation
- (97802 - 97804) medical nutrition therapy
- (97810 - 97814) acupuncture
- (98925 - 98929) osteopathic manipulative treatment
- (98940 - 98943) chiropractic manipulative treatment
- (98960 - 98962) education & training for patient self-management
- (98966 - 98969) non-face-to-face nonphysician services
- (99000 - 99091) special services, procedures and reports
- (99100 - 99140) qualifying circumstances for anesthesia
- (99143 - 99150) moderate (conscious) sedation
- (99170 - 99199) other services & procedures
- (99500 - 99602) home health procedures/services
- (99605 - 99607) medication therapy management services
Category II
- Category II CPT Code(s) – Performance Measurement (optional)[7] (Category II codes: 0001F-7025F)
Category III
- Category III CPT Code(s) – Emerging Technology (Category III codes: 0016T-0207T[8])
Copyright
CPT is a registered trademark of the American Medical Association., and the AMA holds the copyright for the CPT coding system.[9]
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 by Centers for Medicare & Medicaid Services (CMS) and HIPAA, and the data for it appear 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. [10]
Limited CPT Search Offered by the AMA
The AMA offers a limited search of the CPT manual for personal, non-commercial use on its website:
https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do
See also
- Medical classification
- Procedure codes
- ICD-9
- ICD-10-PCS
- HCPCS
- Specialty Society Relative Value Scale Update Committee
References
- ^ AMA (CPT) CPT Process
- ^ Laura Southard Durham (1 June 2008). Lippincott Williams & Wilkins' Administrative Medical Assisting. Lippincott Williams & Wilkins. pp. 2–. ISBN 9780781797894. http://books.google.com/books?id=b9NyTDdaEEsC&pg=RA2-PA102. 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 9781603592161. http://books.google.com/books?id=vZv5RQAACAAJ. 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 9781603592178. http://books.google.com/books?id=-FP1RQAACAAJ. Retrieved 26 May 2011.
- ^ Centers for Medicare & Medicaid Services
- ^ Marie A. Moisio (8 April 2009). Medical Terminology for Insurance and Coding. Cengage Learning. pp. 80–. ISBN 9781428304260. http://books.google.com/books?id=HjYEikV_n6MC&pg=PA80. Retrieved 26 May 2011.
- ^ Holly Hosford-Dunn; Ross J. Roeser; Michael Valente (2008). Audiology practice management. Thieme. pp. 323–. ISBN 9783131164124. http://books.google.com/books?id=r2wBJFACx0wC&pg=PA323. Retrieved 26 May 2011.
- ^ CPT 2010
- ^ AMA (CPT) CPT Licensing
- ^ http://www.ama-assn.org/ama1/pub/upload/mm/37/2009-annual-report.pdf
External links
- Official site by the AMA* Description of the three sections from the AMA
- History from the AMA
- Q&A from the American Academy of Family Physicians
Topographical codes Diagnostic codes Procedural codes HCPCS (CPT, Level 2) · ICD-10 PCS · ICD-9-CM Volume 3 · NIC · SNOMED P axis · OPS-301 · Read codes/OPCS-4 · CCAM · ICHI · LOINCPharmaceutical codes Outcomes codes Categories:- Medical manuals
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