Last week we provided an overview of what ICD-10 codes are. This week we will talk about CPT codes.
CPT, or Current Procedural Terminology codes, are used to identify procedures performed by physicians and healthcare providers. Developed in 1966 by the American Medical Association (AMA), these codes are used by healthcare providers across the US, giving what the AMA calls a “uniform process for coding medical services that streamlines reporting and increases accuracy and efficiency”.
What Are CPT Codes Used For?
CPT codes are used for a variety of purposes. By reporting the services and procedures performed during every visit these codes are used for medical billing, research, and some healthcare documentations. Some places you will see CPT codes are in claims and explanation of benefits. Insurance companies, researchers, and medical coders and billers are some parties involved who will use these codes.
CPT Codes Updates in History
There have been various updates since the earliest codes in 1966, keeping up with medical advances and expanding on the procedures covered by the codes. In the 2nd edition update in 1970, the current 5-digit codes were introduced. The Centers of Medicare and Medicaid Services (CMS) adopted CPT codes into their Healthcare Common Procedure Coding System (HCPCS) for use in Medicare and Medicaid. They are also used by third-party payors. These are divided into 2 levels:
- Level I HCPCS is made up of CPT codes.
- Level II HCPCS is made up of codes that identify products, supplies, and services not included in CPT codes.
CPT Code Examples
There are 3 categories of CPT codes. Each has 5 digits and describe specific services and procedures.
These are for the most common procedures and are widely used. They consist of a 5 digit numerical code to describe procedures. There are 6 sections of Category I CPT codes. These consist of:
- Evaluation and Management Services
- Anesthesia Services
- Pathology and Laboratory Services
- Medical Services
More specific services are under each section. An Appendectomy, for example, has a CPT code of 44950. A Covid-19 vaccine CPT code would be 91300 for Pfizer or 91301 for Moderna for example.
Codes that are used for tracking and for use in data collections regarding patient quality of care. They are a 5 digit code starting with 4 numbers and ending in F as the last digit.
4132F describes a “systemic antimicrobial therapy not prescribed” relating to systemic antimicrobial therapy – avoidance of inappropriate use.
A temporary set of codes for new technology and services. They are a 5 digit code starting with 4 numbers and ending in T.
0640T is for Noncontact near-infrared spectroscopy studies of flap or wound (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [StO2]); image acquisition, interpretation and report, each flap or wound.
There are many codes to describe very specific services and procedures. The AMA has a panel, consisting of 17 members, who maintain and revise the codes. In 2021, there were 329 changes made, some of which resulted in 206 new codes. For resources and updates you can visit the AMA or the CMS for updates and more information on CPT and HCPCS codes.
As a billing company, we are proficient in our understanding of and using of CPT codes in our everyday billing processes. We can create a unique billing platform for your practice or work within the system you currently have. Our expert billing resources will provide you the tools to ensure your practice is successful. Contact us today to learn more about how we can help your healthcare practice.