CPT Coding System Explained

The Current Procedural Terminology coding system is a comprehensive system for identifying medical procedures, services and treatment, for the purposes of insurance reimbursement. The CPT coding scheme is used to communicate clear, unambiguous treatment information among physicians, other health care professionals, patients and third parties, regardless of their location or industry.

History

• The CPT coding system was originally developed and published by the American Medical Association in 1966. The original version contained mainly surgical procedures, but the AMA published a revised version -- which expanded the coding system to five digits, rather than the original four -- in 1970. The revised version contained codes to identify procedures in surgery, medicine, including internal medicine, and other specialties. The CPT coding system has continued to evolve until the present day.

Uses

• The identifying codes and associated descriptive terms employed by the CPT coding system create a universal language that serves several important purposes. The CPT coding system is, in fact, the most widely recognized form of medical terminology, or nomenclature, for private and public health insurance programs. It is equally applicable to medical education and research, where it provides the basis for local, regional and national comparisons of medical treatment.

Category I

• The CPT coding system defines three categories of code, known simply as Category I, Category II and Category III. Category I includes codes for what are known as contemporary medical practices or, in other words, common medical procedures whose results have been satisfactorily proven, documented and approved by the Food and Drug Administration.

Category II

• Category II CPT codes are supplementary codes that measure the quality of medical procedures regulated by the Health Insurance Portability and Accountability Act of 1996. Rather than five digits, category II CPT consist of four digits followed by a letter “F”. Category II CPT codes can be further sub-divided into smaller categories, such as patient history, physical examination and patient safety. Unlike category I CPT codes, their use is optional, but they provide useful information regarding patient care.

Category III

• Category III CPT codes refer to what are known as new and emerging technologies or, in other words, new procedures that have yet to be approved by the Food and Drug Administration. Similar to category II codes, category III CPT codes consist of four digits followed by a letter “T”. However, category III CPT codes are assigned temporarily and deleted if the corresponding procedure isn’t approved by the FDA within 5 years.