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CPT Codes

CPT codes are numerical identifiers for medical services and procedures, developed by the American Medical Association and used globally for billing and reporting. They are categorized into three groups: Category I for common procedures, Category II for performance tracking, and Category III for temporary codes related to new technologies. The structure of these codes varies, with Category I codes being five numeric characters, while Categories II and III include alphanumeric formats.

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97 views12 pages

CPT Codes

CPT codes are numerical identifiers for medical services and procedures, developed by the American Medical Association and used globally for billing and reporting. They are categorized into three groups: Category I for common procedures, Category II for performance tracking, and Category III for temporary codes related to new technologies. The structure of these codes varies, with Category I codes being five numeric characters, while Categories II and III include alphanumeric formats.

Uploaded by

Tariq Syedkazmi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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CPT CODING

Presenter Ain Naqvi


AGENDA

Introduction to CPT Codes


Structure of CPT codes
CPT Categories
Usage of CPT codes
Future of CPT codes

SAMPLE FOOTER TEXT 20XX 2


INTRODUCTION
What Are CPT Codes?
A CPT code is a number used to identify a medical
service or procedure. CPT codes are used by healthcare
providers for reporting, billing, and administration
purposes.

The American Medical Association (AMA) develops,


maintains, and has copyrighted the CPT codes that are
currently used in over 60 countries.2 These codes can
change as healthcare changes, and new codes can be
made and assigned to new services.

Current CPT codes can also be revised and unused


codes thrown out. Thousands of CPT codes are used and
updated every year.
SAMPLE FOOTER TEXT 20XX 3
STRUCTURE OF CPT CODES

The structure of a CPT® code consists of five characters, and the code can
either be entirely numeric or alphanumeric, depending on the category it
belongs to.

Category I Codes:
Format: Five numeric characters. Examples: 33275, 99213, 80047

Category II Codes:
Format: Four numeric characters followed by the letter "F.“ Examples 3006F,
0503F & 2000F

Category III Codes:


Format: Four numeric characters followed by the letter "T.“ Examples 0042T,
0510T
CPT CODES CATEGORIES

20XX 5
CPT CODES CATEGORIES
CPT (Current Procedural Terminology) codes are used to describe
medical, surgical, and diagnostic services. They are essential for billing
and documentation in healthcare. The CPT code structure is divided into
three main categories:

Category I: These codes represent the most common and widely


performed procedures and services. They are divided into sections such
as Evaluation and Management, Anesthesia, Surgery, Radiology,
Pathology and Laboratory, and Medicine.

Category II: These are tracking codes used for performance


measurement. They help in collecting data on the quality of care and are
often used for performance improvement initiatives.

Category III: These are temporary codes for emerging technologies,


20XX 6
CATEGORY I CPT CODES
Purpose: These are most used set of codes represent widely used, FDA-
approved medical services and procedures, such as surgeries, diagnostic
tests, and patient evaluations.

Structure: Composed of five numeric characters (e.g., 99213 for an


office visit).

Here’s a quick look at the sections of Category I CPT codes, as arranged


by their numerical range.

•Evaluation and Management: 99201 – 99499


•Anesthesia: 00100 – 01999; 99100 – 99140
•Surgery: 10021 – 69990
•Radiology: 70010 – 79999
•Pathology and Laboratory: 80047 – 89398 20XX 7
CATEGORY II CPT CODES

Category II CPT codes are alphanumeric, five-character codes used to


provide additional details related to Category I codes. They are optional
and not used for reimbursement but are valuable for performance
management and improving patient care. These codes consist of four
digits followed by an "F" and help track clinical processes, outcomes, and
quality measures.

For example, if a doctor documents a patient's Body Mass Index (BMI)


during a checkup, the code 3008F ("BMI documented") is used. These
codes never replace Category I or Category III codes but provide
supplementary information

20XX 8
CATEGORY II CPT CODES CLASSIFICATION
1.Key sections of Category II codes include:

1.Composite Codes (0001F–0015F)


2.Patient Management (0500F–0584F)
3.Patient History (1000F–1505F)
4.Physical Examination (2000F–2060F)
5.Diagnostic/Screening Processes or Results (3006F–3776F)
6.Therapeutic, Preventive, or Other Interventions (4000F–4563F)
7.Follow-up or Other Outcomes (5005F–5250F)
8.Patient Safety (6005F–6150F)
9.Structural Measures (7010F–7025F)
10.Non measure Code Listing (9001F–9007F)

20XX 9
CATEGORY III CPT CODES

Category III codes, depicted with four numbers and the letter T, typically follow Category
II codes in the code book. Category III codes are temporary codes that represent new
technologies, services, and procedures.

Temporary codes describing new services and procedures can remain in Category III for
up to five years. If the services and procedures they represent meet Category I criteria —
which includes FDA approval, evidence that many providers perform the procedures, and
evidence that the procedures have proven effective — they'll be reassigned Category I
codes. Conversely, Category III codes can be removed if providers don't use them.

20XX 10
CATEGORY III CPT CODES EXAMPLES
Here are some examples for Category III Codes .

Emerging Technologies:
0042T: Cerebral perfusion analysis using CT.
0075T: Transcatheter placement of extracranial vertebral artery
stent(s).

Experimental Procedures:
0202T: Posterior vertebral joint arthroplasty (e.g., facet joint
replacement).
0219T: Optical coherence tomography (OCT) of the breast, including
interpretation and report.

New Services:
0295T: External ECG recording for 48 hours to 7 days with continuous
20XX 11
THANK YOU

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