What Are CPT Codes?

Revenue Integrity Blog- What Are CPT Codes?

In healthcare, CPT (Current Procedural Terminology) codes are numbers used to describe the tests, surgeries, evaluations, and any other medical procedure performed by healthcare providers at an institution or hospital. Published twice a year and maintained by the American Medical Association (AMA), the code sets are extremely large and include thousands upon thousands of codes representing medical procedures. It is, along with ICD codes, one of the most important coding sets that medical researchers, physicians, and other hospital staff must learn.

What Are CPT Codes?

A CPT code is a numerical five-digit code that has been developed, maintained and copyright protected by the American Medical Association. CPT has been the medical language to communicate across health care which enables seamless processes and advanced analytics in medical services. Codes measure the prevalence and value of certain procedures and hospitals can evaluate their efficiency throughout the year. As a healthcare system evolves, new codes can be developed for new services, current codes can be revised, and old, unnecessarily generated codes can be discarded.

CPT codes help describe medical procedures.

Melanie Grant, a certified medical coder, does an excellent job explaining the beginning basics of CPT codes here.

How Are CPT Codes Created and Maintained?

The CPT data set is updated twice a year by the CPT editorial panel with the help of the perspectives of clinical and industry experts. A committee meets three days each year to review applications for updated codes or revisions to existing codes or revisions of codes already in use.

In many healthcare systems, there are specific medical coders that work within the CPT code set to make sure providers are using the correct ICD codes and CPT codes for billing purposes.

CPT codes help report clinical statistics. These statistics are then taken to the AMA for review along with recommendations from healthcare providers. Finally, the AMA panel keeps, updates, or discards codes. This happens twice a year.

Types of CPT Codes

The evidence-based codes of the CPT represent an extensive array of services covering all aspects of mental and physical health. CPT codes can either be numeric or alphanumeric according to their classification. Code descriptions are clinically focused and employ common standards so that a varied set of stakeholders can have a common understanding of how each section pertains to the procedures used in patient care.

Category I CPT Codes

These are common codes and are widely used in medical billing and coding and revenue cycle management.

00000-09999 – Anesthesia Services
10000-19999 – Integumentary System
20000-29999 – Musculoskeletal System
30000-39999 – Respiratory, Cardiovascular, Hemic, and Lymphatic System
40000-49999 – Digestive System
50000-59999 – Urinary, Male Genital, Female Genital, Maternity Care, and Delivery System
60000-69999 – Endocrine, Nervous, Eye and Ocular Adnexa, Auditory System
70000-79999 – Radiology Services
80000-89999 – Pathology and Laboratory Services
90000-99999 – Evaluation & Management Services

Category II CPT Codes

These codes are supplemental and are used for reporting performance measures reducing the necessity for chart review and medical records abstraction.

0001F-0015F – Composite measures
0500F-0575F – Patient management
1000F-1220F – Patient history
2000F-2050F – Physical examination
3006F-3573F – Diagnostic/screening processes or results
4000F-4306F – Therapeutic, preventive, or other interventions
5005F-5100F – Follow-up or other outcomes
6005F-6045F – Patient safety
7010F-7025F – Structural measures

Category III CPT Codes

These are temporary codes and describe emerging and experimental technologies, services, and procedures. Since this section is the most frequently updated, it’s best to visit the AMA’s Category III section to stay up to date on this specific CPT code set.

CPT codes are organized into 3 categories. Category one are commonly used codes, category two reports on performance, and finally category three are temporary or experimental codes.

2021 CPT Code COVID-19 Updates

In the wake of the COVID-19 pandemic, there have been several major updates to the CPT codes manual. These new CPT codes are unique for each coronavirus vaccine as well as administration codes unique to each such vaccine. The new codes clinically distinguish each coronavirus vaccine for better tracking, reporting, and analysis that supports data-driven planning and allocation.

A full list of the COVID-19 CPT code updates can be found here.

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Why Are CPT Codes Useful?

The CPT coding system is incredibly important for healthcare providers to make sure they are correctly logging and billing the correct procedures for the correct patient. Without a code set to match services to, hospitals would have no way of tracking this data. When there are errors related to CPT coding, there can be incorrectly billed services, miscommunication between departments, and more. This creates massive revenue integrity issues that can affect the entire revenue cycle of a hospital system. It’s vital to strictly adhere to and audit your coding process to ensure these kinds of errors don’t occur, and if they ever do, to swiftly resolve them.