Continue reading for answers to commonly asked questions around CPT codes. Use the table of contents below to jump ahead to any question.
Table of Contents
What is Current Procedural Terminology?
CPT stands for Current Procedural Terminology. It is a set of codes created by the American Medical Association (AMA®) to standardize how medical procedures are recorded in a medical chart.
Why are CPT codes used?
CPT codes are one of the primary ways that both public and private medical providers and healthcare institutions can report the services they have provided to patients to the government and insurance companies for reimbursement purposes. CPT codes are part of the national coding system under the Health Information Portability and Accountability Act (HIPAA).
CASE STUDY SPOTLIGHT
As Piedmont Healthcare expanded its footprint, they found that their new locations didn’t always speak the same language when it came to surgical and procedure codes. In fact, procedure terms were not mapped to Current Procedural Terminology (CPT®) codes that help ensure accurate scheduling and prior authorization approval.
Learn how integrating IMO Health’s surgical terminology and scheduling solution into their EHR allowed them to have each term accurately mapped to the corresponding CPT codes – strengthening communication and accuracy throughout the organization.
How are CPT codes maintained?
CPT codes are maintained by the CPT Editorial Board, a part of the AMA, and are updated once a year. The new codes are released annually in November, and go into effect on the following January 1. The editorial board meets three times a year to review applications for new codes.
What do CPT codes look like?
CPT codes are five characters long and are usually numeric, although some may be alphanumeric depending on what category they fall into.
What are the “categories” you mentioned?
The CPT manual is divided into three categories, each with distinct purposes outlined below:
Category I
- Used to report the devices and drugs used during a procedure
- Used to report the procedure itself to the billing department
- Contains the billable codes needed for reimbursement
Category II
- Designed for reporting performance measures
- Used to provide data to regulatory agencies
- Does not contain billing codes
- Primarily thought of as “quality of care” codes
Category III
- Codes for documenting new procedures, clinical trials and emerging technologies
- Must be either added to Category I or deleted within five years of being added
Another important code set to pair with CPT is the Healthcare Common Procedure Coding System (HCPCS). By presenting HCPCS codes alongside standard CPT codes in EHR scheduling workflows, clinicians and schedulers easily capture increased detail for each procedure.
To learn more, read our blog, Boost surgery scheduling, efficiency, and claims accuracy with HCPCS coding.
CPT is a registered trademark of the American Medical Association. All rights reserved.
