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| Abbreviated commonly as [[CPT]], the '''Current Procedural Terminology''' ('''CPT''') code set is a [[medical coding|medical code set]] maintained by the [[American Medical Association]] through the CPT Editorial Panel.
| | Current Procedural Terminology |
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| == CPT code set ==
| | The '''Current Procedural Terminology''' (CPT) is a medical code set maintained by the American Medical Association (AMA) through the CPT Editorial Panel. The CPT code set is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies, and accreditation organizations. |
| The CPT code set (copyright protected by the AMA) describes medical, surgical, and diagnostic services. They are designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes. | |
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| | ==History== |
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| | The CPT code set was first developed and published by the American Medical Association in 1966. It was created to provide a uniform language that accurately describes medical, surgical, and diagnostic services, thereby serving as an effective means for reliable nationwide communication among physicians, patients, and third parties. |
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| == New editions == | | ==Structure== |
| New editions are released each October.
| | CPT codes are divided into three categories: |
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| 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
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| == Level 1 coding system ==
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| CPT is currently identified by the Centers for Medicare and Medicaid Services (CMS) as Level 1 of the [[Healthcare Common Procedure Coding System]]. | |
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| The Current Procedural Terminology (CPT) was developed by the American Medical Association (AMA).<ref name="cms.hhs" />
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| ==Types of code==
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| There are three types of CPT code: Category I, Category II, and Category III.
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| ===Category I=== | | ===Category I=== |
| Category I CPT Code(s). There are six main sections:<ref name="Moisio2009">{{cite book|author=Marie A. Moisio|title=Medical Terminology for Insurance and Coding|url=https://books.google.com/books?id=HjYEikV_n6MCandpg=PA80|accessdate=26 May 2011|date=8 April 2009|publisher=Cengage Learning|isbn=978-1-4283-0426-0|pages=80–}}</ref> | | Category I CPT codes are the most commonly used codes and consist of five numeric digits. These codes represent procedures that are consistent with contemporary medical practice and are widely performed. They are organized into six sections: |
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| ====Codes for evaluation and management: 99201–99499====
| | * [[Evaluation and Management]] |
| * (99201–99215) [[Outpatient|Office/other outpatient services]]
| | * [[Anesthesia]] |
| * (99217–99220) [[Medical observation|Hospital observation]] services
| | * [[Surgery]] |
| * (99221–99239) [[Inpatient|Hospital inpatient]] services
| | * [[Radiology]] |
| * (99241–99255) [[Consultation (doctor)|Consultations]]
| | * [[Pathology and Laboratory]] |
| * (99281–99288) [[Emergency department]] services
| | * [[Medicine]] |
| * (99291–99292) [[Intensive care medicine|Critical care]] services
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| * (99304–99318) [[Nursing facility]] services | |
| * (99324–99337) Domiciliary, rest home ([[nursing home|boarding home]]) or custodial care services
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| * (99339–99340) Domiciliary, rest home ([[assisted living facility]]), or home care plan oversight services
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| * (99341–99350) [[home care|Home health]] services
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| * (99354–99360) Prolonged services
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| * (99363–99368) [[Medical case management|Case management]] services
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| * (99374–99380) Care plan oversight services
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| * (99381–99429) [[Preventive medicine]] services
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| * (99441–99444) [[Telemedicine|Non-face-to-face physician services]]
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| * (99450–99456) Special evaluation and management services
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| * (99460–99465) [[Neonatal care|Newborn care]] services
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| * (99466–99480) [[NICU|Inpatient neonatal intensive, and pediatric/neonatal critical, care services]] | |
| * (99487–99489) [https://www.supercoder.com/cpt-codes-range/2959 Complex chronic care coordination] services
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| * (99495–99496) [[Transitional care]] management services
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| * (99499) Other evaluation and management services
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| ====Codes for anesthesia: 00100–01999; 99100–99150====
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| * (00100–00222) [[head]]
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| * (00300–00352) [[neck]]
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| * (00400–00474) [[thorax]]
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| * (00500–00580) [[intrathoracic]]
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| * (00600–00670) [[Vertebral column|spine]] and [[spinal cord]]
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| * (00700–00797) upper abdomen<ref>{{cite web|url=https://www.supercoder.com/cpt-codes-range/26 |title=Anesthesia for Procedures on the Upper Abdomen |accessdate=2016-10-04 |url-status=live |archiveurl=https://web.archive.org/web/20161005122825/https://www.supercoder.com/cpt-codes-range/26 |archivedate=2016-10-05 }}, Anesthesia for procedures on the upper abdomen</ref>
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| * (00800–00882) lower abdomen<ref>{{cite web|url=https://www.supercoder.com/cpt-codes-range/30 |title=Anesthesia for lower abdomen}},Anesthesia for procedures on the lower abdomen </ref>
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| * (00902–00952) [[perineum]]
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| * (01112–01190) [[pelvis]] (except hip)
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| * (01200–01274) [[upper leg (except knee)]]
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| * (01320–01444) [[knee and popliteal area]]
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| * (01462–01522) [[lower leg (below knee)]]
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| * (01610–01682) [[shoulder]] and [[axilla]]ry
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| * (01710–01782) [[upper arm and elbow]]
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| * (01810–01860) [[forearm, wrist and hand]]
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| * (01916–01936) [[radiology|radiological procedures]]
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| * (01951–01953) [[burn excisions or debridement]]
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| * (01958–01969) [[obstetric]]
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| * (01990–01999) [[other procedures]]
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| * (99100–99140) [[qualifying circumstances for anesthesia]]
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| * (99143–99150) [[moderate (conscious) sedation]]
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| ====Codes for surgery: 10000–69990====
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| * (10000–10022) general
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| * (10040–19499) [[integumentary system]]
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| * (20000–29999) [[musculoskeletal system]]
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| * (30000–32999) [[respiratory system]]
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| * (33010–37799) [[cardiovascular system]]
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| * (38100–38999) [[hemic]] and [[lymphatic system]]s
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| * (39000–39599) [[mediastinum]] and [[Thoracic diaphragm|diaphragm]]
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| * (40490–49999) [[digestive system]]
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| * (50010–53899) [[urinary system]]
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| * (54000–55899) [[human male genitalia|male genital system]]
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| * (55920–55980) [[reproductive system]] and [[intersex]]
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| * (56405–58999) [[human female genitalia|female genital system]]
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| * (59000–59899) [[maternity care]] and [[Childbirth|delivery]]
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| * (60000–60699) [[endocrine system]]
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| * (61000–64999) [[nervous system]]
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| * (65091–68899) [[human eye|eye]] and [[ocular adnexa]]
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| * (69000–69979) [[auditory system]]
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| ====Codes for radiology: 70000–79999====
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| * (70010–76499) [[diagnostic radiology]]
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| * (76500–76999) [[diagnostic ultrasound]]
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| * (77001–77032) [[radiologic guidance]]
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| * (77051–77059) breast [[mammography]] | |
| * (77071–77084) [[bone]]/[[joint studies]] | |
| * (77261–77999) [[radiation oncology]] | |
| * (78000–79999) [[nuclear medicine]]
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| ====Codes for pathology and laboratory: 80000–89398====
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| * (80000–80076) [[organ or disease-oriented panels]]
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| * (80100–80103) [[drug testing]]
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| * (80150–80299) [[therapeutic drug assays]] | |
| * (80400–80440) [[evocative/suppression testing]]
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| * (80500–80502) [[consultations (clinical pathology)]]
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| * (81000–81099) [[urinalysis]]
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| * (82000–84999) [[chemistry]]
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| * (85002–85999) [[hematology]] and [[coagulation]]
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| * (86000–86849) [[immunology]]
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| * (86850–86999) [[transfusion medicine]]
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| * (87001–87999) [[microbiology]]
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| * (88000–88099) [[anatomic pathology (postmortem)]]
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| * (88104–88199) [[cytopathology]]
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| * (88230–88299) [[cytogenetic studies]]
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| * (88300–88399) [[surgical pathology]]
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| * (88720–88741) [[in vivo (transcutaneous) lab procedures]]
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| * (89049–89240) [[other procedures]]
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| * (89250–89398) [[reproductive medicine procedures]]
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| ====Codes for medicine: 90281–99099; 99151–99199; 99500–99607====
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| * (90281–90399) [[immune globulins]], [[Serum (blood)|serum]] or [[recombinant prods]]
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| * (90465–90474) [[immunization administration]] for [[vaccines]]/[[toxoids]]
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| * (90476–90749) [[vaccines, toxoids]]
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| * (90801–90899) [[psychiatry]]
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| * (90901–90911) [[biofeedback]]
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| * (90935–90999) [[dialysis]]
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| * (91000–91299) [[gastroenterology]]
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| * (92002–92499) [[ophthalmology]]
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| * (92502–92700) [[special otorhinolaryngologic services]]
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| * (92950–93799) [[cardiovascular]]
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| * (93875–93990) [[noninvasive vascular diagnostic studies]]
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| * (94002–94799) [[pulmonary]]
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| * (95004–95199) [[allergy and clinical immunology]]
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| * (95250–95251) [[endocrinology]]
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| * (95803–96020) [[neurology and neuromuscular procedures]]
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| * (96101–96125) [[central nervous system assessments/tests (neuro-cognitive, mental status, speech testing)]]
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| * (96150–96155) [[health and behavior assessment/intervention]]
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| * (96360–96549) [[hydration, therapeutic, prophylactic, diagnostic injections and infusions, and chemotherapy and other highly complex drug or highly complex biologic agent administration]]
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| * (96567–96571) [[photodynamic therapy]]
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| * (96900–96999) [[special dermatological procedures]]
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| * (97001–97799) [[physical medicine and rehabilitation]]
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| * (97802–97804) [[medical nutrition therapy]]
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| * (97810–97814) [[acupuncture]]
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| * (98925–98929) [[osteopathic manipulative treatment]]
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| * (98940–98943) [[chiropractic manipulative treatment]]
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| * (98960–98962) education and training for patient self-management
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| * (98966–98969) non-face-to-face nonphysician services
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| * (99000–99091) special services, procedures and reports
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| * (99170–99199) other services and procedures
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| * (99500–99602) home health procedures/services
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| * (99605–99607) medication therapy management services
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| ===Category II=== | | ===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 CPT codes are supplemental tracking codes that can be used for performance measurement. These codes are optional and are not required for correct coding. They consist of four digits followed by the letter "F." |
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| 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: | | ===Category III=== |
| | Category III CPT codes are temporary codes for emerging technology, services, and procedures. These codes consist of four digits followed by the letter "T." |
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| * (0001F–0015F) Composite measures
| | ==Usage== |
| * (0500F–0584F) Patient management
| | CPT codes are used by healthcare providers to report medical procedures and services to payers for reimbursement. They are also used for administrative management purposes such as claims processing and developing guidelines for medical care review. |
| * (1000F–1505F) Patient history
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| * (2000F–2060F) Physical examination
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| * (3006F–3776F) Diagnostic/screening processes or results
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| * (4000F–4563F) Therapeutic, preventive or other interventions
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| * (5005F–5250F) Follow-up or other outcomes
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| * (6005F–6150F) Patient safety
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| * (7010F–7025F) Structural measures
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| * (9001F–9007F) Non-measure claims-based reporting
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| 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.<ref>AMA coding manual</ref> | | ==Updates== |
| | The CPT code set is updated annually to reflect changes in medical practice. The CPT Editorial Panel meets three times a year to consider proposals for new codes and revisions to existing codes. |
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| ===Category III=== | | ==Relation to Other Code Sets== |
| * Category III CPT Code(s) – Emerging technology (Category III codes: 0016T-0207T<ref>CPT 2010</ref>)
| | CPT codes are used in conjunction with other code sets such as the [[International Classification of Diseases]] (ICD) codes and the [[Healthcare Common Procedure Coding System]] (HCPCS) codes. While ICD codes are used to describe diagnoses, CPT codes describe the procedures and services provided. |
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| ==See also== | | ==See Also== |
| * [[Medical classification]] | | * [[Healthcare Common Procedure Coding System]] |
| * [[Procedure code]]
| | * [[International Classification of Diseases]] |
| * [[ICD|ICD-9]] | | * [[Medical Billing]] |
| * [[ICD-10]] | | * [[American Medical Association]] |
| * [[ICD-10-PCS]] | |
| * [[Health Care Procedure Coding System|HCPCS]]
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| * [[Specialty Society Relative Value Scale Update Committee]]
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| ==External links==
| | {{Medical-stub}} |
| * [https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do Official site] by the AMA
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| * [https://www.aapc.com/resources/medical-coding/cpt.aspx What is CPT®] by the AAPC
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| {{Medical classification}}
| | [[Category:Medical coding]] |
| {{stub}}
| | [[Category:Healthcare]] |
| {{adapted}}
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| [[Category:Medical manuals]] | |
| [[Category:American Medical Association]] | | [[Category:American Medical Association]] |
| [[Category:Clinical procedure classification]]
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Current Procedural Terminology
The Current Procedural Terminology (CPT) is a medical code set maintained by the American Medical Association (AMA) through the CPT Editorial Panel. The CPT code set is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies, and accreditation organizations.
History[edit]
The CPT code set was first developed and published by the American Medical Association in 1966. It was created to provide a uniform language that accurately describes medical, surgical, and diagnostic services, thereby serving as an effective means for reliable nationwide communication among physicians, patients, and third parties.
Structure[edit]
CPT codes are divided into three categories:
Category I[edit]
Category I CPT codes are the most commonly used codes and consist of five numeric digits. These codes represent procedures that are consistent with contemporary medical practice and are widely performed. They are organized into six sections:
Category II[edit]
Category II CPT codes are supplemental tracking codes that can be used for performance measurement. These codes are optional and are not required for correct coding. They consist of four digits followed by the letter "F."
Category III[edit]
Category III CPT codes are temporary codes for emerging technology, services, and procedures. These codes consist of four digits followed by the letter "T."
CPT codes are used by healthcare providers to report medical procedures and services to payers for reimbursement. They are also used for administrative management purposes such as claims processing and developing guidelines for medical care review.
Updates[edit]
The CPT code set is updated annually to reflect changes in medical practice. The CPT Editorial Panel meets three times a year to consider proposals for new codes and revisions to existing codes.
Relation to Other Code Sets[edit]
CPT codes are used in conjunction with other code sets such as the International Classification of Diseases (ICD) codes and the Healthcare Common Procedure Coding System (HCPCS) codes. While ICD codes are used to describe diagnoses, CPT codes describe the procedures and services provided.
See Also[edit]
