2 Sept 2017

CPT Guidelines

CPT (Current Procedural Terminology) By AMA (American Medical Association) published annually (Jan 1st) is used to assign five-digit codes for procedure/service performed by the physicians / other health care professionals.

Divisions in CPT book

    Category I     (E&M, Anesthesia, Surgery, Radiology, Pathology, & Medicine)
    Category II    (4 digits followed by the letter F)
    Category III   (4 digits followed by the letter T) 

Category I Codes:

Section Numbers and their sequences
           1.    E&M               - 99201 - 99499   
           2.    Anesthesia    - 00100 – 01999, 99100 - 99140
           3.    Surgery          - 10021 - 69990
           4.   Radiology      - 70010 - 79999
           5.   Pathology      - 80047 - 89398
           6.   Medicine       - 90281 – 99199, 99500 – 99607 

How to use the Book

        Select the procedure code from the alphabets index given at the end of the CPT book. There are four primary classes of main entries,

           1.  Procedure / Service – For Eg: Endoscopy, splint
           2.  Organ / Anatomic site – For Eg: Colon, Tibia
           3.  Condition -  For Eg: Abscess, Tetralogy of Fallot
           4.  Abbreviation – For Eg: EEG

Refer the respective CPT description along with the parenthetical notes given below the CPT code, and related CPT guidelines (Specific guidelines are given at the beginning of each section).

If there is no CPT code available in the CPT book that exactly describes the service provided, don’t code which is near approximates instead we can report appropriate unlisted procedure codes.

CPT codes are arranged like Stand-alone code and one or more indented code. 

         Eg:     CPT 73120 (Radiologic examination of hand; 2 views)                                        
                   CPT 73130 (Minimum of three views)

                   For CPT 73130 Should read this as a Radiologic examination of hand; minimum of three views.

Symbols used in the CPT book

          1.   Add on codes +
          2.   New code   
          3.                 Revised code 
          4.   New or revised text
          5.   Exemption to modifier 51
          6.   Out of numerical sequence code #


  Ø  Add on codes is always performed in addition to the primary service / Procedure.

  Ø  Must never be reported as a stand-alone code

  Ø  Never append modifier 51 with add on codes

  Ø  Add on codes concept applies only to add on service or procedure performed by the same physician.

Category II Codes - Used for performance measurement

Category III Codes - Temporary codes for emerging technology, this code must be reported instead of unlisted code.