CPT Guidelines for Outpatient Coding

Current Procedural Terminology (CPT) codes are five-digit numerical sequences published by the American Medical Association (AMA). There are over 7,000 codes that describe surgical, medical, and diagnostic services including both outpatient and inpatient codes.

Categories

• There are 10 categories covered under outpatient CPT codes. These include integumentary system, which includes the skin, hair and nails; musculoskeletal system; respiratory system; cardiovascular/hemic and lymphatic systems; digestive system; urinary and male genital systems; female genital systems; nervous system; eye/auditory systems; and ancillary services including radiology, oncology and laboratory departments.

Medicare and CPT

• Effective in 2000, Medicare replaced its fee-for-service reimbursement system with an outpatient prospective payment system. This change required medical coders to have the ability to not only recognize the CPT system, but also have a fuller understanding of the definitions and applications of certain codes in connection to patient information.

Updates

• Updates of the CPT coding rules are released each year, providing additional codes, clarification of existing codes and expanded definitions. These updates are done in response to changes within the individual categories. For instance, RN Melanie Witt reported on the 2010 updates for ObGyn CPT updates, that new codes for the bundling of three common urodynamic procedures were established due to the AMA's belief that the procedures were overvalued when coded separately.