The current procedural terminology (CPT) benefits health care workers in the US. The current procedural terminology (CPT) code system helps medical professionals communicate about procedures and services.
But what is current procedural technology exactly, and how is it used to benefit the health care industry? Keep reading for everything you need to know.
- The American Medical Association (AMA) has developed the Current Procedural Terminology (CPT), a system of standardized codes used by healthcare providers to identify specific medical services, diagnostic exams, and procedures.
- CPT is utilized for billing and reimbursement purposes, documentation of clinical records, and quality improvement efforts in the healthcare industry.
- The CPT structure is broken down into three sections: Category I, Category II, and Category III codes.
- The benefits of using CPT codes include increased accuracy & efficiency in the documentation and billing & reimbursement processes; increased compliance with healthcare regulations & requirements; improved communication between stakeholders; and improved patient care outcomes.
Definition of Current Procedural Terminology (CPT)
American Medical Association (AMA) developed the current procedural terminology (CPT) for various reasons. Current procedural terminology uses standardized codes that healthcare providers use to specify healthcare services, diagnostic exams, and medical or surgical procedures.
In other words, CPT is a way to keep track of all the different things that happen when a patient visits a healthcare provider. Some specific functions where CPT can be used to indicate medical issues are:
Billing & Reimbursement
Medical employees use CPT codes in billing healthcare services. These bills go to government payers and insurance companies. A code represents a specific service. At the same time, this code also determines a reimbursement amount which may vary depending on the paying company.
Healthcare providers can use CPT codes to document medical services. At the same time, the procedures on a medical record would also fit in. Through this, they can track patients’ health and detailed steps taken in the treatment progress.
Moreover, they can use the code to communicate with their colleagues.
CPT codes are like tracking numbers for medical procedures and treatments. They help doctors, insurers, and medical personnel stay accurate, efficient, and consistent in delivering healthcare services by ensuring uniformity across systems and reminding further steps.
Furthermore, the codes are updated annually by the AMA’s CPT editorial panel, which evaluates existing codes and creates new ones to keep up with advancements in medical technology and healthcare services.
The AMA also provides support and training to healthcare providers on how to use the codes effectively. By maintaining and improving the codes, the AMA ensures that reimbursement practices and medical billing are standardized and consistent throughout the healthcare industry.
Structure of CPT
The structure of the CPT is divided into three sections:
Category I Code
Category I uses 5-digit codes to report medical procedures and services. Each code has a procedure or service description. It represents medical services like surgery or physical examination.
These are the codes that are most commonly used in the CPT system. The AMA updates the codes every year to reflect the several changes in medical technology and practice.
Category II Code
Unlike Category I, Category II codes are optional codes. These codes are for reporting quality indicators as well as performance measures. These four-digit codes get information on the quality of care delivered to patients.
If a patient receives a preventive service, the personnel uses a Category II code.
Category II is also called supplemental codes and is not reimbursable. This means that healthcare providers don’t bill using these codes. At the same time, payers don’t reimburse with these codes as well.
Category III Code
CPT also has temporary codes for reporting newly developed procedures, services, and technologies. These codes are under Category III.
Category III are 4-digit codes to get information on recent developments. This new technology can go to Category I if it is widely accepted.
The development of the CPT code by AMA involves several steps:
1. Identifying Potential Changes
This is the part where the AMA gets feedback from different stakeholders. These include healthcare providers, government agencies, and insurers. The feedback will determine potential code changes and is a regular inbuilt process.
2. Submit Proposals
Proposals include new code requests, code revisions, or the deletion of obsolete codes. The CPT Editorial Panel will be the one receiving these proposals.
3. Proposal Review
The CPT editorial panel will then review the submitted proposals. This review involves the proposal’s clinical relevance, the potential for widespread use, and its impact on the healthcare industry.
4. Creating a Draft Code Set
After the review, the panel will now create a draft code. The draft includes new codes as well as those revised and deleted.
The CPT advisory committee then reviews the draft code created. This will ensure that the codes are accurate and reflect current medical practice.
5. Publishing the New Code Set
Once finalized, the AMA will now publish the new code set. This contains new guidelines and other supporting documents in the coding manual.
CPT Code Sections
The CPT code set has each category 1 code, each representing a medical procedure or service. Let’s talk about these sections and give some examples as well:
1. Evaluation & Management Codes
These are codes for reporting doctor consultations and other types of patient-doctor encounters. Examples include
- Hospital visits
- Outpatient visits
- Consultations with other medical professionals
2. Anesthesia Codes
Anesthesia codes are utilized to denote the administration of anesthesia during diagnostic or surgical procedures. Some examples of these codes may include:
- Regional anesthesia
- General anesthesia
- Anesthesia care monitoring
3. Surgery Codes
Surgeons who conduct surgical procedures are the ones who use the surgery codes. Some indicative surgical procedures they do that involve codes are:
- Hernia repair
4. Pathology & Laboratory Codes
Pathology and laboratory codes are a subset of CPT codes that describe laboratory and pathology procedures. Examples include:
- Tissue biopsies
- CBC and other blood tests
5. Radiology Codes
Radiology codes are used to describe diagnostic and therapeutic radiology services. Examples include:
- CT Scans
6. Medicine Codes
This includes procedures and medical services that don’t fit the other sections. Here, we can include the following:
Benefits of Using CPT Codes
Using the CPT codes can undeniably improve patient care as well as outcomes. This is possible in many ways, such as:
High Accuracy in Documentation
CPT codes deliver a standardized approach to documenting medical services and procedures. This will ensure that medical providers use the same language to provide care.
This high standard guarantees effective communication between various levels of healthcare providers. Moreover, it minimizes misunderstandings and lowers the risk of committing errors.
Payment & Reimbursement
Codes determine the payment and reimbursement for medical services and procedures. This ensures healthcare providers will be fairly paid for the services they deliver.
CPT motivates them to be better and consistent in developing new technologies and having higher quality care for their patients.
Using CPT codes has several benefits regarding compliance with healthcare regulations and requirements. For instance, CPT codes provide a standardized way to describe medical procedures and services.
By using these codes, healthcare providers can ensure that their billing accurately reflects the services provided, reducing the risk of overbilling or underbilling. This helps healthcare organizations stay compliant with healthcare regulations and avoid potential penalties.
One major benefit of using CPT codes is that they can significantly increase efficiency in healthcare practices. With standardized codes, medical billing and coding processes become synchronous and more streamlined and accurate, reducing the likelihood of errors or discrepancies.
This can lead to faster claims processing and reimbursements, ultimately improving standards and the practice’s financial health. Additionally, CPT codes can help improve patient care by providing detailed descriptions of the procedures and services.
This information can be used to track patient progress, identify trends in healthcare utilization, and develop treatment plans tailored to each patient’s needs.
The terminologies of medical procedures and services can be complex and difficult to describe. Still, CPT codes provide a common language that healthcare providers, insurers, and patients can use to communicate more effectively.
By using standardized codes, everyone involved in the care process can better understand the services provided and ensure they are accurately communicated and documented.
This improved communication can have many benefits. For example, it can help reduce confusion and misunderstandings, leading to better patient outcomes.
It can also make it easier for healthcare providers to coordinate their part of patient or client care with other providers, ensuring that patients receive the most non-duplicating, appropriate, and effective treatment.
In addition, using CPT codes can help patients become more engaged in their healthcare. By understanding the procedures and services provided, patients can make more informed decisions about their care and participate more actively in the care process.
Frequently Asked Questions
Which current procedural terminology coding section are general surgery codes found?
General surgery codes are found in the CPT manual’s surgery section. This section divides into subsections which are based on the organ involved. The section also includes codes for different surgical procedures.
How is the current procedural terminology used?
The Current Procedural Terminology is used in many ways in the healthcare industry.
Some examples include:
– Research & Analysis
How many categories does the current procedural terminology consist of?
The Current Procedural Terminology (CPT) is composed of three categories:
1. Category I: Most commonly used codes for describing medical services and procedures done by healthcare providers
2. Category II: Supplemental tracking codes for quality improvement and performance measurement
3. Category III: Temporary codes for data and research as well as for emerging services, procedures, and technologies
And there you have it — an introduction to current procedural terminology. CPT has come a long way, from its humble beginnings to its crucial role in modern health care. We hope you’ve gained a new appreciation for current procedural terminology and what it represents.
After all, CPT codes aren’t just a random assortment of digits — they’re the building blocks that keep our health care system running smoothly. So, the next time you visit your doctor, remember that behind every procedure, every diagnosis, and every treatment, there’s a current procedural terminology code that helps make it all possible.
- American Medical Association. “Default Homepage.” American Medical Association, 2019, www.ama-assn.org/
- CPT Purpose & Mission. American Medical Association, www.ama-assn.org/about/cpt-editorial-panel/cpt-purpose-mission
- Dotson, Peggy. “CPT® Codes: What Are They, Why Are They Necessary, and How Are They Developed?” Advances in Wound Care, vol. 2, no. 10, Dec. 2013, pp. 583–87, https://doi.org/10.1089/wound.2013.0483
- AAPC. “CPT – CPT Codes – Current Procedural Terminology – AAPC.” Aapc.com, 2019, www.aapc.com/resources/medical-coding/cpt.aspx.
- American Medical Association. “CPT® Overview and Code Approval.” American Medical Association, 2019, www.ama-assn.org/practice-management/cpt/cpt-overview-and-code-approval.