The document provides an overview of CPT coding, including the history and organization of CPT codes, mandated reporting of CPT codes, non-reportable services, the six sections of CPT codes, and symbols and notes used in CPT coding. It describes the structure of CPT codes including sections, subsections, categories, and subcategories, and discusses unlisted procedures and services. The document aims to introduce healthcare providers to the CPT coding system.
2. WHAT ARE WE DOING HERE?
Coding Systems….how many?
What are the differences?
Who uses what?
……our focus for AHMS 160
3. History of CPT
1966
Published by AMA
1970
Five-digit codes
1983
Adopted as part of HCPCS
(continued)
4. History of CPT
1986
Omnibus Budget Reconciliation Act (OBRA)
1996
HIPAA
2004
MMA
5. CPT Mandated Reporting
Home health care and hospice agencies
Outpatient hospital departments
Physicians who are employees of health care facility
Physicians who see patients in their offices or clinics and
in patients’ homes
6. CPT Mandated Reporting
Home health care and hospice agencies
Outpatient hospital departments
Physicians who are employees of health care facility
Physicians who see patients in their offices or clinics and
in patients’ homes
8. Examples of Non-Reportable Services
Administering sedatives
Cleansing, shaving, and prepping of skin
Draping and positioning of patient
Irrigating wound
Inserting and removing drains
9. CPT Categories
Category I codes
Procedures and services
Category II codes
Performance measures
Category III codes
Emerging technology
10. Organization of CPT
Six sections
Evaluation and Management (E/M) (99201–99499)
Anesthesia (00100–01999, 99100–99140)
Surgery (10021–69990)
Radiology (70010–79999)
Pathology and Laboratory (80048–89398)
Medicine (90281–99199, 99500–99607)
11. CPT Index
Alphabetic main terms
Boldfaced
Represent procedures or services, organs, anatomic
sites, conditions, eponyms, or abbreviations
Subterms indented below
13. CPT Index
Organization
Procedures or services (e.g., endoscopy)
Organs or other anatomic sites (e.g., elbow)
Conditions (e.g., wound)
Synonyms (e.g., finger joint or intercarpal joint)
Eponyms (e.g., Whitman procedure)
Abbreviations (e.g., MRI)
(continued)
14. CPT Index
Boldfaced type
Main terms, categories, subcategories, and code numbers
Italicized type
Cross-reference terms (e.g., see)
Directs coders to index entry under which codes are listed
15. Appendices
Appendix A
List of modifiers and descriptions
Appendix B
Annual CPT coding additions, deletions, and revisions
Appendix C
Clinical examples for codes found in E/M section
(continued)
16. Appendices
Appendix D
List of add-on codes
Identified with plus symbol (+)
Appendix E
List of codes exempt from modifier -51
Appendix F
List of codes exempt from modifier -63
(continued)
17. Appendices
Appendix G
Summary of CPT codes identified with bull’s eye symbol
Codes that include Moderate (Conscious) Sedation (MCS)
(continued)
18. Appendices
Appendix H
*Removed from CPT; Alphabetical Listing is available from
the AMA web site: www.ama-assn.org/go/cpt
Appendix I
Genetic testing modifiers
(continued)
19. Appendices
Appendix J
Electrodiagnostic medicine listing of sensory, motor, and
mixed nerves
Appendix K
List of codes pending Food and Drug Administration (FDA)
approval
(continued)
20. Appendices
Appendix L
List of vascular families
Appendix M
List of deleted CPT codes and descriptions with crosswalk
to new CPT codes
21. CPT Symbols
Bullet located to the left of code identifies new procedures
and services
Triangle located to the left of code identifies revision of
code description
Horizontal triangle symbols surround revised guidelines
and notes
(continued)
22. CPT SYMBOLS
Plus identifies add-on codes for procedures commonly, but
not always, performed at the same time and by the same
surgeon as the primary procedure (+)
23. CPT Symbols
Circle with slash identifies forbidden or prohibited codes
exempt from modifier -51
Bull’s eye identifies procedure that includes MCS
Flash identifies codes that classify products pending FDA
approval
(continued)
25. CPT Guidelines
Define terms and explain assignment of codes for
procedure and services
Located at beginning of each CPT section
Guidelines from one CPT section do not apply to another
CPT section
Should be reviewed before assigning code
26. Sections, Subsections, Categories, and
Subcategories
Six sections subdivided into the following:
Subsections
Categories
Subcategories
Guidelines at beginning of each subsection
(continued)
28. Unlisted Procedures and Services
Unlisted procedure or unlisted service
Assigned when provider performs procedure or service for
which there is no CPT code
Special report must accompany claim to provide more
information
e.g., copy of procedure report
29. Sections, Subsections, Categories, and
Subcategories
Notes, parenthetical notes, and descriptive qualifiers in
each section, subsection, category, and subcategory
31. Descriptive Qualifiers
Terms that clarify assignment of CPT code
Can you find the descriptive qualifier in code 35188?
That’s right; head and neck qualifies the procedure as
opposed to the same procedure involving the thorax and
abdomen or extremities.