The Current Procedural Terminology (CPT) coding system is the universal system of medical practitioner codes used by hospitals, physicians and other healthcare providers to document information about treatment and other medical services, for the purposes of insurance reimbursement. CPT codes are used in order to ensure treatment information can be understood by any healthcare professional, regardless of region or industry. The codes are developed and maintained by the American Medical Association (AMA). The coding system is updated periodically, the most current version being CPT 2010.
The CPT coding system is divided into three categories, simply referred to as Category I, Category II and Category III. (Note: The CPT coding system is separate from Level I of the HCPCS coding system maintained by the CMT, though the two systems are identical.)
Category I CPT Code(s) – Contemporary Medical Practices
These codes identify modern, common medical procedures as approved by the FDA and practiced by medical professionals everywhere. These are procedures for which results have been satisfactorily proven and documented. Codes in this category are updated annually, and a new edition of the CPT is released.
Within category 1 codes, there are six further categories of procedure that are identified:
- Evaluation and Management
- Pathology and Laboratory
Each procedure is given a 5-digit numeric code. Codes are generally arranged in a sensible order, such that related procedures have relatively similar numbers.
Category II CPT Code(s) – Performance Measurement
Category II codes are supplementary tracking codes used to measure the effectiveness and quality of certain measurable medical procedures, as regulated by HIPAA. They collect information about the quality of care delivered for record-keeping purposes, in order to support good patient care.
These codes are composed of four digits followed by the letter F, and are divided into smaller categories as follows:
- Composite Measures – 0001F
- Patient Management – 0500F-0503F
- Patient History – 1000F-1002F
- Physical Examination – 2000F
- Diagnostic/Screening Processes or Results – 3000F
- Therapeutic, Preventive or Other Interventions – 4000F-4011F
- Follow-up or Other Outcomes – 5000F
- Patient Safety – 6000F
The use of these codes is optional, and they are not intended to serve the purpose of Category I codes.
Category III CPT Code(s) – New and Emerging Technologies
These codes are intended to track the use and effectiveness of new procedures and services which are either still undergoing research, or have not yet been approved by the FDA. They are used both to measure the use of these procedures, and to provide supportive data concerning the procedure’s widespread practice and clinical effectiveness, which furthers the cause of the procedure being approved.
These codes are composed of four digits followed by the letter T. They are assigned temporarily, and are deleted if the procedure in question is not approved within five years.
Updated CPT code editions can be found on the website of the American Medical Association.