CPT and HCPCS Coding

CPT Category 1

CPT (Current Procedural Terminology) level one codes are procedure codes generally used by physicians and in other outpatient settings. They are updated annually. 

A procedure is any action taken by the doctor and staff for the treatment or diagnosing the patient. CPT can also be divided in to category as follows:

Anesthesia: This is the practice of giving pain numbing medicines to patients for surgery. (00001-09999)

Evaluation and Management: These are services where the doctor will assess your problem, make a diagnosis and recommend treatment, but does not do any surgery or testing. Previously we noticed a pattern in bold print spelling out SOAP. SOAP is a common evaluation and management method. It also helps the doctor know what to write in his/her notes.  (99201-99255)

Surgery: These are invasive codes, meaning to go through the skin. The surgery section is further divided by body system such as musculoskeletal (skin, muscle and bone) or cardio-vascular and respiratory (heart, veins and arteries and lungs). (10000-69999)

Radiology: Radiology describes diagnostic or therapeutic procedures involving several different forms of x-ray. (7000-79999)

Pathology: These services include the analysis of blood, tissue and urine (80000-89999)

Medicine: The medicine section encompasses all other medical services that do not fit in to the sections above including non radiology diagnostic services and non surgical therapeutic treatments, physical therapy and chiropractic. (90000-99100)

Category II and III

Both category 2 and 3 codes are for reporting purposes. They report medical treatment outcomes and assessments of clinical trials and new technologies.  They are generally not reimbursable (they don’t get paid) and are used in addition to traditional CPT level 1 codes as appropriate.  Not all physicians report using these codes so it is important to ask the provider is they do or if they are involved in clinical trials. To follow is the official description of category 2 and 3 codes from the AMA web site:

“Category II CPT Codes are intended to facilitate data collection by coding certain services and/or test results that are agreed upon as contributing to positive health outcomes and quality patient care. This category of CPT codes is a set of optional tracking codes for performance measurement. These codes may be services that are typically included in an Evaluation and Management (E/M) service or other component part of a service and are not appropriate for Category I CPT codes.”

“The purpose of this category of codes is to facilitate data collection on and assessment of new services and procedures. These codes are intended to be used for data collection purposes to substantiate widespread usage or in the FDA approval process. As such, the Category III CPT codes may not conform to the usual CPT code requirements that:

Services/procedures are performed by many health care professionals across the country;    FDA approval be documented or be imminent within a given CPT cycle; and the service/procedure has proven clinical efficacy.”  (http://www.ama-assn.org/ama/pub/category/12886.html)

HCPCS

HCPCS codes include all products or items used in medical treatment and service codes which have not yet been assigned to CPT. It also includes non-medical care such as ambulance transportation. An example of HCPCS are known as durable medical equipment (DME) which are supplies provided to patients that can be used repeatedly such as crutches or a wheel chair. Other examples of HCPCS are medications or drugs, surgical trays, and bandages.