What Are CPT Codes: An Overview

You’ve likely heard an assortment of complex terminology and lingo if you’ve spent much time in the field of medicine. As you become increasingly familiar with these domain-specific phrases, you may still be wondering: What are CPT codes? Or more specifically, What are the three categories of CPT codes?

CPT codes are authorized and maintained by the American Medical Association (AMA), who work to provide a standardized reporting process that encourages accuracy and efficiency. Formally known as Current Procedural Terminology (CPT) codes, these numbers are used to uniformly label medical procedures and services.

CPT codes are routinely maintained, evaluated, and assigned by the AMA’s CPT Editorial Panel. This independent group of experts ensures that codes are evidence-based and meet certain qualifications.

What Are CPT Codes?

To put it simply, CPT codes are the numbers assigned to the treatments and services delivered by a healthcare provider. Physicians primarily use the CPT codes to report the specific care given under their watch (nurses and other providers typically don’t use these codes). The codes communicate important information to other medical institutions, healthcare insurers, medical researchers, and others with access to the communications.

Healthcare insurers in the U.S. process over 5 billion claims for payment each year. One main use of CPT codes is to identify services in such billing transactions. These codes are used in conjunction with the provider’s NPI number to share a comprehensive account of the care provided.

Use of CPT codes, in turn, contributes to the process of medical review — the analysis of health records to verify that Medicare and Medicaid payments are being made for applicable services that fall under specific requirements. Without uniform CPT codes, it would be difficult to identify the services and fraudulent claims would be more common.

CPT codes are also used when tracking healthcare usage, by showing the rate at which procedures or services are being used. This standardized categorization allows for easier data collection, which can contribute to future research, decision-making, and funding practices.

What Are the Three Categories of CPT Codes?

While all CPT codes have five-digits, some codes use only numbers while others use both numbers and letters. The specific attributes of a code depend on which of the three categories of CPT codes it falls under.

Category 1: Procedures and Services

The first group of codes corresponds to a procedure or service. As the most commonly used CPT codes, they’re used to identify services like office visits, laboratory tests, and surgical procedures. Devices and drugs, including vaccines, also are reported here. This is the only category of codes that medical providers are required to use.

These codes range from 00100-99499, and are further organized into subcategories based on the type of service. To illustrate one CPT code example, digits ranging from 70000-79999 notate services related to radiology.

Category 2: Performance Measurement

These CPT codes are used as optional, supplemental codes for performance measurement and quality improvement. While not mandatory, these codes can indicate the reason for the patient’s visit or the patient’s history, which may reduce the need for chart review.

Category 2 codes are alphanumeric — including both numbers and letters — with four numbers followed by one letter. They are also divided into subcategories, as in the first category. For instance, any codes that fall within 1000F–1220F represent information related to the patient’s history.

Category 3: Emerging Technology

The final group of CPT codes records the use of emerging technology, services, or procedures. These codes are temporarily assigned and allow for the collection of data, which helps researchers track the usage of services that aren’t yet widely used in clinical practice.

These alphanumeric codes are constantly changing, depending on the AMA’s yearly designation of codes. Emerging technology CPT codes are typically used for data collection, although some may be used in billing for new services that don’t yet qualify for a Category 1 code.

Where to Find a List of CPT Codes

Now that you know what CPT codes are, you’re likely wondering where to find a CPT code you may need in a given situation. To perform a CPT code lookup, you’ll need access to the annual list of CPT codescopyrighted by the AMA. There’s a variety of ways to gain access to these codes and many avenues allow them to be imported into your organization’s electronic system.

One way providers can access the list of CPT codes is on the Centers for Medicare & Medicaid Services (CMS) website, which provides an updated code list each year. You’ll be asked to verify a licensing agreement, affirm use within the U.S. solely by your organization, and attest to CPT code usage for Medicare, Medicaid, or other programs provided by CMS.

Once you gain access to the codes, you can search within the categories to choose the relevant CPT medical abbreviation: respiratory, digestive, anesthesia, and more. This will allow your organization to accurately record the care you’re providing to your patients and residents and maintain billing compliance.

While we’ve outlined one way to access CPT codes, it’s important for your organization to perform additional research about how to best attain CPT codes, as different methods offer various features. There are also differing costs associated with CPT code lookup options.

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Now that you know the answer to the question, What are CPT codes? you’ll be better prepared to accurately report your facility’s services. Stay connected with IntelyCare to get the latest free nursing care resources for your facility.