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Current Procedural Technology Codes (CPT)

Current Procedural Technology Codes (CPT)

Overview

CPT was developed by the American Medical Association and first published in 1966. The current version, CPT 2008, is sometimes referred to as “CPT-4” because it is the fourth edition of CPT (the annual updates are not considered new editions). CPT Codes are updated through a deliberative process of adding, deleting, and revising codes. CPT codes are updated and revised by the AMA’s CPT Editorial Panel, on an annual basis. According to the AMA, "The Panel is comprised of 16 members, 11 nominated by the AMA and one each from the Blue Cross and Blue Shield Association, the Health Insurance Association of America, HCFA [now CMS], the American Hospital Association, and the co-chair of the Health Care Professionals Advisory Committee (HCPAC).” CPT is used primarily for reporting physician services (i.e., “professional services”) and “technical component” services provided in conjunction with professional services.

Policy

CPT is divided into six main “sections,” followed by thirteen appendices and an alphabetic index. The CPT codes are listed in numeric order within sections and subsections, including: Evaluation and Management; Anesthesia; Surgery; Radiology; Pathology and Laboratory; and Medicine. Each of the main sections is further divided into subsections. For example, the surgery section is generally divided into one subsection for each major body “system.” Section guidelines appear at the beginning of each of the six CPT sections. In addition, subsection guidelines appear at the beginning of most of the subsections. In general, the section and subsection guidelines provide definitions and the information necessary to properly select CPT codes from the applicable section/subsection.

CPT codes are five-digit numeric codes. Modifiers are used to provide additional information about the service performed (or the circumstances under which the service was performed) that goes beyond the CPT code description. Modifiers are two digit numeric codes preceded by a hyphen (e.g., -51 Reduced Services) that are appended to the CPT code.

Agency Guidance

Using CPT properly requires training and experience; however, the general process for assigning a CPT code is as follows: • Review the clinical documentation and identify the term or terms that best describe the service provided. • Look up the term or terms that best describe the service provided in the CPT index to identify the code that appear to apply. • Look up the selected code in the main body of CPT to make definitive code selection. Pay careful attention to the applicable section and subsection guidelines and to any other notes contained in the manual. Also, pay careful attention to the use of indentations and semicolons. In some cases, a related code is indented and printed below another code. Only the portion of the description of the first code up to the semicolon (referred to as the “common portion”) should be treated as a part of the indented code. • Determine whether any modifiers are required and, if so, select the appropriate modifiers from Appendix A of CPT.

Excerpt from Robert A. Pelaia, Introduction to Medical Coding for Lawyers, Fundamentals of Health Law (American Health Lawyers Association November 2011).