Current Procedural Terminology (CPT) code

Current Procedural Terminology (CPT) is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations. CPT codes are used in conjunction with ICD-9-CM or ICD-10-CM numerical diagnostic coding during the electronic medical billing process.

There are three types of CPT codes: Category 1, Category 2 and Category 3. CPT is a registered trademark of the American Medical Association.

Category 1: Procedures and contemporary medical practices

Category 1 covers procedures and contemporary medical practices that are widely performed. Category 1 is the section coders usually identify with when talking about CPT and are five-digit numeric codes that identify a procedure or service that is approved by the Food and Drug Administration (FDA), performed by healthcare professionals nationwide, and is proven and documented.

Category 1 codes are broken down into six sections:

  • evaluation and management
  • anesthesiology
  • surgery
  • radiology
  • pathology and laboratory
  • medicine

Category 2: Clinical Laboratory Services

The Category 2 CPT medical code set consists of the supplementary tracking codes that are used for performance measures and are intended to help collect information about the quality of care delivered. The use of this medical code set is optional and is not a substitute for Category 1 codes.

Category 3: Emerging technologies, services and procedures

The Category 3 CPT code list consists of temporary codes that cover emerging technologies, services and procedures. They differ from the Category 1 medical CPT codes list in that they identify services that may not be widely performed by healthcare professionals, may not have FDA approval and also may not have proven clinical efficacy. To be eligible, the service or procedure must be involved in ongoing and planned research. The purpose of these CPT codes is to help researchers track emerging technologies and services.

Requirements for submitting Category 1 and 3 codes

CPT code list vs. ICD codes

Simply put, the difference between CPT codes and ICD codes are that CPT codes are related to procedures and ICD codes are related to diagnoses.

CPT codes, or procedural codes, describe what kind of procedure a patient has received while ICD codes, or diagnostic codes, describe any diseases, illnesses or injuries a patient may have.

Psychotherapy code revisions

The 2017 psychotherapy code revisions consist of two changes. The first change is the description of psychotherapy CPT codes. In 2016 the description was "Psychotherapy, 30 minutes with patient and/or family member." In 2017 the description was changed to "Psychotherapy, 30 minutes with patient."

The second change is to the description of family psychotherapy CPT codes. Whereas before there was no time indicated in the description. The 2017 revision clarifies in order to bill the service, the clinician must meet the midpoint of 50 minutes. In other words, the clinician must provide at least 25 minutes of documented service.

Commonly used CPT codes

The six most commonly used CPT codes for medical billing are the following:

  • new patient office visit codes: codes used to bill for patients that have never been seen by any physician in the same specialty within the same group in the last three years;
  • established patient office visit codes: used to bill for patients that have been seen by a physician in the same specialty within the same group before in the last three years;
  • initial hospital care for new or established patients codes: used to bill for patients that are admitted to a hospital;
  • subsequent hospital care codes;
  • emergency department visit codes; and
  • office consultation codes: used for patients seeking the opinion of a physician at the request of another physician.

How CPT codes are formatted and why

CPT codes are made up of five characters. These characters could be numeric and alphanumeric depending on which category -- the division of the CPT code set -- the CPT code is in. Unlike ICD, each number or character in a CPT code does not correspond to a particular procedure or technology.

CPT codes are designed to be flexible and allow for revision.

New CPT codes for 2017

New CPT codes were added to the following categories for 2017:

  • moderate sedation;
  • Modifier 95 and Appendix P, which allow reporting for synchronous telemedicine services
  • musculoskeletal
  • neurology
  • respiratory
  • cardiovascular
  • digestive
  • female genital system
  • radiology
  • pathology
  • medicine section
  • Category 3
This was last updated in June 2015

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