The CPT coding system was dirst developed and published by the AMA in 1966 as a method of billing for medical and surgical procedures and services using standard terminology. Three editions of Current Procedural Terminology were published in the 1970s, and updates and revisions reflected changes in teh technology and practices of health care. Use of the CPT manual was increased in 1983 when teh Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration(HCFA), incorporated the CPT codes into the Healthcare Common Procedural Coding System (HCPCS).
In 2003, the AMA is anitcipatin the publication of the next generation of the CPT, CPT-5. The major changes in the CPT 5 will be the use of terminology that more clearly describes services and procedures.
The revisions in the CPT-5 were necessary to address requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
The bullet symbol: In the CPT manual, new codes for procedures and services are identified with the bullet symbol that is placed in front of the code number.
A triangle placed in front of a code indicates that the description for the code has been changed or modified since the previous edition. Changes may be additions, deletions, or revisions in code descriptions. When the text changes a right and left triangle indicate teh beginning and end of teh text changes.
The plus symbol + placed in front of a code indicates an add-on code. Add-ons are never used alone; rather, they are used with another primary procedure or service code.
The star * placed after a code number indicates that the service includes surgical procedures only. The starred mirror procedure is discussed later in more detail along with the modifier -51 exempt code and the add-on code.
Appendix b of teh CPT manual contains a complete list of the additions to, deletions from, and revisions of the previous edition of the CPT manual. If the procedure or service is still available but is to be reported with a different code, the deleted code is listed, followed by the new code to be used.
SECTION: At the top of teh page, the word "Surgery" indicates the section. Note that this word is followed by a range of numbers, which is a list of all teh code numbers located on that page.
SUBSECTION: Also at the top of the page, the phrase "Integumentary System" indicates the subsection.
SUBHEADING: The word"Breast" indicates teh subheading.
CATEGORY: The word "Incision" indicates teh subheading.
Modifiers provide additional information to the third party payer about services provided to a patient. At times, the five-digit CPT code may reflect completely the service or procedure provided. Because numeric codes, not written procedure descriptions, are required by third-party payers, additional numbers or letters may be added to the basic five-digit code to modify the CPT code and thereby provide further specificity.
Category III was a new addition to teh 2002 CPT. Category III contains codes for emerging technology; they are temporary codes. If there is a Category III code for the service or procedure you are reporting, you must use the Category III code for the service or procedure you are reporting, you must use the Category III code, not the Category I unlisted code.
Single Code: When only one code number is stated, you should verify the code in the main portion of the CPT manual to ensure its accuracy. Multiple Code: The use of a comma between code numbers indicates the presence of only those numbers displayed. If more than one code number is listed, then all codes must be referenced to make an accurate choice.
Range of Codes: A range is indicated by a hyphen. When a range is given in teh index, you must look up each code with the range in the main portion of the CPT manual to select teh appropriate code from the range.
CAUTION: Never code directly from the index. You can't be sure you have the right code until you have located the code in the main portion of the CPT manual and read the information presented there regarding the specifics of the code.
LOCATION METHODS:
Service or procedure
Anatomic Site
Condition or Disease
Synonym
Eponym
Abbreviation
Appendix B: located near the back of teh CPT manual; contains a complete list of addtions to, deletions from, and revisions of the previous addition.
Appendix C: located near the back of the CPT manual; contains the list of updates to teh electronic version of the CPT.
Appendix D: located near the back of the CPT manual; presents clinical examples of Evaluation/Management E/M Procedures.
Appendix E: located near the back of the CPT manual; contains a listing of the CPT add-on codes
Appendix F: located near the back of teh CPT manual; contains a list of modifier -51 exempt codes.
CPT (CURRENT PROCEDURAL TERMINOLOGY): a coding system developed by the American Medical Association (AMA) to convert widely accepted, uniform descriptions of medical, surgical, and diagnostic services rendered by health care providers into five-digit numeric codes
Guidelines: provide specific instructions about coding for each section; the Guidelines contain definitions for terms, applicable modifiers, explanations of notes, subsection information, unlisted services, special reports information, and clinical examples.
Modifiers: two- or five-digit numbers added to CPT codes to supply more specific information about the services provided to the patient.
Sections: the seven major areas of into which all CPT codes and descriptions are categorized.
See: a cross-reference system within the index of the CPT manual used to direct the coder to an-other term or other terms. The See indicates that the correct code will be found elsewhere
Special reports: detailed reports that include adequate definitions or descriptions of the nature, extent, and need for the procedure and the time, effort, and equipment necessary to provide the services
Subsections: the further division of sections into smaller units, usually by body systems
Symbols: special guides that help the coder compare codes and descriptors with the previous edition. A bullet is used to indicate a new procedure or service code added since the previous edition of the CPT manual. A solid triangel placed in front of a code number indicates that the code has been changed or modified since the last edition. A star * placed after a code number indicates a minor procedure. A plus + is used to indicate an add-on code. A circle with a line through it is used to identify modifier 51 exempt codes. A right and left triange indicate the beginning and end of text changes.
Term location methods:service/procedure, anatomic site/body organ, condition/disease, synonym, eponym, and abbreviation
Unlisted procedures: procedures that are considered unusual, experimental, or new and do not have specific code number assigned; unlisted procedure codes are located at the end of teh subsections and subheadings and may be used to identify any procedure that lacks a specific code.
