CURRENT PROCEDURE

TERMINOLOGY (CPT)

ABOUT CPT CODES

Describe the procedure, service, or
technology performed or utilized by the
healthcare provider
Created, maintained, and copyrighted by the
American Medical Association (AMA)

CPT CODE FORMAT

Each code is five characters long
Numeric or alphanumeric, depending on
which Category the code is in
Not the same as ICD category

Code set is divided into three Categories

Category I: procedure codes
Category II: supplemental tracking codes designed
to reduce administrative burden
Category III: codes for emerging and
experimental procedures and services

CATEGORY I
The largest and most commonly used
Category
Contains codes for procedures, medication,
technology, services and more
Arranged, for the most part, in numerical
order
Divided into six main sections

SIX SECTIONS OF CPT: E&M

Evaluation and Management (E&M)
Codes 99201 99499
Listed at front of code book for ease of access
Includes codes for patient visits, assessments,
treatment recommendations
Includes commonly used codes like 99214, for a
routine doctors visit

ANESTHESIOLOGY
Codes 00100 01999; 91000 99150
Includes codes for anesthetic procedures,
divided by where on the body the procedure
is performed

SURGERY
Codes 10021 69990
Largest and most complex section of CPT
manual
Includes codes for any invasive or surgical
procedure
Divided by where on the body the procedure
takes place
Each section then subdivided by what type of
surgery it is, e.g. excision

RADIOLOGY
Codes 70010 79999
Codes for diagnostic radiology (e.g., X-rays)
and nuclear medicine
Divided by where on the body the procedure
is performed

PATHOLOGY AND LABORATORY

Codes 80047 89398
Codes for laboratory tests, tests that
determine the root of a patients illness

MEDICINE
Codes 90281 99199; 99500 99607
Includes codes for drugs and medication
administered orally and otherwise

GUIDELINES
Each section has its own guidelines for use
Surgery has instructions for how to report extra
materials used, for example

Many codes will also direct you out of the

section to find the more accurate code

PARENT CODES
Similar to ICD
Parent codes are procedures that have a
number of variations
The parent code is the root version of the
procedure (e.g., liver management; simple
suture)
The variation (e.g., complex suture) is
indented below the parent code
Variations replace the initial description that
follows the semicolon in the parent code

PARENT CODES CONT.

EXAMPLE:
47350: Liver management; simple suture
47360: complex suture

If we select code 47360, we would read this is

as Liver management; complex suture

MODIFIERS
Two-character additions added to the end of
the CPT code
Give information about the procedure
without changing the definition of the
procedure itself
CPT modifiers are always numerical
HCPCS modifiers, which are often used in
CPT codes, are alphanumeric
CPT modifiers: see CPT Modifiers in section 2
HCPCS modifiers: see HCPCS Modifiers in section 2

INSTRUCTIONS WITHIN THE CODE SET

Many codes have instructions for their use
In (parentheses) below the code
Provide coders with similar procedures that
may be better suited to the procedure they
are trying to code
May also instruct coder to use multiple codes
E.g., use with code 12345

May also instruct when to use Add-on

codes
Codes that must be used in tandem with other
codes and are not standalone

May inform the coder that the code is

modifier exempt

CATEGORY I REVIEW
Category I codes
Are five digits, numeric
Are divided into six sections: E&M, Anesthesia,
Surgery, Radiology, Pathology and Laboratory,
Medicine
Are grouped numerically and in numeric order,
aside from E&M codes
Have variations that are indented below the
parent code
Have instructions and guidelines for use for use
Have modifiers

CATEGORY II CPT CODES

Five characters long
Alphanumeric (mix of letters and numbers)
Always end in F
EXAMPLE: A doctor records a patients Body Mass
Index (BMI)
Use code 3008F: Body Mass Index (BMI)
documented

Category II codes never replace Category I or

Category III codes, but are added to them

SECTIONS OF CATEGORY II
Composite codes
These codes combine a number of procedures
that typically occur in conjunction with one main
procedure.
Example: 0001F: heart failure assessed (includes all of the
following):
Blood pressure measured
Level of activity assessed
Clinical symptoms of volume overload assessed
Weight recorded
Clinical signs of volume overload assessed

SECTIONS OF CATEGORY II CONT.

Patient Management
Includes patient care provided for specific clinical
purposes like pre- and postnatal care
Example: 0503F: Postpartum care visit

Patient History
Describes measures for select elements of patient
history or symptom review
Example: 1030F: Pneumococcus immunization status assessed

SECTIONS OF CATEGORY II CONT.

Physical Examination
Example: 2014F: Mental status assessed

Diagnostic/Screening Processes or Results

Includes results of tests ordered, including clinical
lab tests and radiological procedures
Example: 3006F: Chest X-ray documented and reviewed

Therapeutic, Preventive, or Other

Interventions
Describes pharmacologic, procedural or
behavioral therapies
Example: 4037F: influenza immunization ordered or
administered

SECTIONS OF CATEGORY II CONT.

Follow-up or Other Outcomes
These codes describe the review and
communication of test results to a patient, patient
satisfaction, patient functional status, and patient
morbidity or mortality
Example: 5005F: patient counseled on self-examination for
new or changing moles

Patient Safety
Includes codes that describe patient safety
precautions
Example: 6015F: Patient receiving or eligible to receive foods,
fluids, or medication by mouth

SECTIONS OF CATEGORY II CONT.

Structural Measures
This short section includes codes that describe the
setting of the delivered care, and also covers the
capabilities of the healthcare provider
Example: 7025F: patient information entered into a reminder
system with a target due date for the next mammogram

CATEGORY III
Five characters
Alphanumeric
Always end in T
Eg, 0123T: fistulization of sclera for glaucoma,
through ciliary body

Describe emerging medical procedures,

services, and technologies that have not been
added to Category I yet

CATEGORY III CONT.

You may think of Category III codes as codes
that may become Category I codes at some
point
To become a Category I code, a procedure must be
performed a number of different times by
providers in multiple different locations
The CPT Editorial Board decides which codes
become Category I

CATEGORY III CONT.

Category III codes have sunset dates
If the code is not added to Category I by that date,
it will no longer be listed in Category III, and that
procedure will have to be marked using a
Category I unlisted procedure code, with a
supplemental note
Codes are listed in Category III for five years