|  | Healthcare Industry | General Healthcare Industry

CPT Coding Rules

Current Procedural Terminology (CPT) is a list of descriptive terms and identifying codes. The American Medical Association (AMA) developed CPT in 1966. It uses uniform language to describe medical, surgical and diagnostic services, and helps physicians, health care providers, patients and third parties communicate more effectively. The CPT Editorial Panel updates and modifies CPT codes, descriptors, rules and guidelines.

  1. Category I CPT Codes

    • Category I CPT codes describe a medical procedure or service and are identified by a five-digit number and descriptor nomenclature. New codes must conform to rules established by the CPT Editorial Panel. The procedure/service must be approved by the Food and Drug Administration, the procedure/service must be performed by physicians across the United States, the procedure/service must be well established, the procedure/service must be unique and the procedure/service must not be based on the performance of another procedure/service.

    Category II CPT Codes

    • Category II CPT codes are optional. These codes measure performance. According to the rules, performance measurements must be developed and tested by a national organization; evidence-based measurements must be tied to health outcomes; measurements must address clinical conditions of high prevalence, high risk or high cost; and the measurements must be used by the health care industry.

    Category III CPT Codes

    • Category III CPT codes track new and emerging technologies. These codes facilitate data collection and assessment of new services and procedures. According to the rules, there must be protocols in place to study new procedures, there must be specialist support, there must be peer-reviewed literature and there must be on-going clinical trials.

    CPT Code Changes

    • Individuals may suggest revisions, additions, deletions or modifications to the CPT codes. Coding change request forms are available through the AMA. The CPT Advisory Committee reviews the forms before ruling on the proposed coding changes. The AMA staff evaluates the code changes.

General Healthcare Industry - Related Articles