CPT Codes List in Medical Billing

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CPT Codes List in Medical BillingA system was created by the American Medical Association in 1966 and this one is still used until now. Do you know what the system is called and what is the function of the system? At first, the system was made to codify the surgical procedures only. However, the thing was changed in 1983 when it was adopted by the Health Care Financing Administration of HCFA (which now is known as the Centers for Medicare & Medicaid Services) to report all provider services or CMS.

The guidelines for electronic health data storage and transmission were created by the Health Insurance Portability and Accountability Act or HIPAA in 1996. Not only that, the CPT system was also created to identify the medical operations.

CPT codes are not the same as ICD-10 codes. They are two different things. Instead of identifying the treatment performed, the CPT codes are the one that identify the medical diagnosis. These kinds of codes are also important for billing insurance companies due to the fact that they are the ones that explain why the CPT code treatment was given.

The term CPT is like the language that is spoken between the providers and the payers. It is a set of medical codes that are widely used by a lot of people, including physicians, non-physician practitioners, allied health professionals, outpatient facilities, hospitals, and laboratories. The function of these codes is to describe the procedures and the services performed by them. More specifically, they are the ones that are used to report the procedures and services to the federal and private payers to get the reimbursement.

In order to support the world of healthcare that keeps improving, every year, the CPT code set is updated by the American Medical Association or AMA. Usually, there are some new ones. Aside from that, there might also be some revised and deleted ones. In addition, the coding guidelines to CPT can also be changed.

Last year, the American Medical Association or AMA announced the 2021 Current Procedural Terminology or CPT. While it was released in 2020, the code set has only become effective starting from January 1 this year. There are several changes compared to the previous ones. As shown in Journal of AHIMA, there are a total of 329 CPT code changes for 2021. These codes include 206 code additions, 54 code deletions, and 69 code revisions. Below is the summary of the changes for each CPT code section:

  • Evaluation and Management Services
    Added: 2
    Deleted: 1
    Revised: 17
  • Anesthesia
    Added: 0
    Deleted: 0
    Revised: 0
  • Surgery
    Added: 11
    Deleted: 11
    Revised: 28
  • Radiology Procedures
    Added: 2
    Deleted: 2
    Revised: 6
  • Pathology and Laboratory Procedures
    Added: 43
    Deleted: 1
    Revised: 9
  • Medicine Services and Procedures
    Added: 18
    Deleted: 9
    Revised: 4
  • Category II Codes
    Added: 0
    Deleted: 0
    Revised: 1
  • Category III Codes
    Added: 45
    Deleted: 23
    Revised: 1
  • PLA Codes
    Added: 85
    Deleted: 7
    Revised: 3

Here are the details of these CPT codes:

  • Section: 00100-01999
    Code range: 00100-01999
    CPT sections: Anesthesia
  • Section: 10004-69990
    Code range: 10004-69990
    CPT sections: Surgery
  • Section: 70010-79999
    Code range: 70010-79999
    CPT sections: Radiology Procedures
  • Section: 0001U-89398
    Code range: 0001U-89398
    CPT sections: Pathology and Laboratory Procedures
  • Section: 90281-99607
    Code range: 90281-99607
    CPT sections: Medicine Services and Procedures
  • Section: 99091-99499
    Code range: 99091-99499
    CPT sections: Evaluation and Management Services
  • Section: 0001F-9007F
    Code range: 0001F-9007F
    CPT sections: Category II Codes
  • Section: 0002M-0018M
    Code range: 0002M-0018M
    CPT sections: Multianalyte Assay
  • Section: 0042T-0670T
    Code range: 0042T-0670T
    CPT sections: Category III Codes
  • Section: CPT Modifiers
    Code range: CPT Modifiers
    CPT sections: Modifiers

CPT codes are divided into three categories, including Category I, Category II, and Category III. The codes in Category I are the biggest body of the codes. It consists of the codes that are widely used by the providers to report their services and procedures. Most CPT codes are included in this category. The main sections of CPT codes in this category include:

  • Evaluation & Management Services (99202 – 99499)
  • Anesthesia Services (01000 – 01999)
  • Surgery (10021 – 69990)
  • Radiology Services (70010 – 79999)
  • Pathology and Laboratory Services (80047 – 89398)
  • Medical Services and Procedures 990281 – 99607)

The codes in Category II are described as the supplemental tracking codes that are usually used for performance management. They are different compared to the ones in Category I as they are not linked to reimbursement. The codes in this category are used by the providers to help them deliver better healthcare and get better results for the patients. The codes included in this category are able to be found in the CPT code book right after the ones in Category I. Here is how these codes is arranged:

  • Composite Measures (0001F – 0015F)
  • Patient Management (0500F – 0584F)
  • Patient History (1000F – 1505F)
  • Physical Examination (2000F – 2060F)
  • Diagnostic/Screening Processes or Results (3006F – 3776F)
  • Therapeutic, Preventive, or Other Inventions (4000F – 4563F)
  • Follow-up or Other Outcomes (5005F – 5250F)
  • Patient Safety (6005F – 6150F)
  • Structural Measures (7010F – 7025F)
  • Non-measure Code Listing (9001F – 9007F)

As for the codes that are included in category III, they are the ones that are used to report emerging and experimental services and procedures. The temporary ones that describe the new services and procedures can always be included in this category for a maximum of five years. It is possible for the codes to be reassigned Category I codes as long as the services and procedures they represent meet the criteria in Category I. For those who have no idea, these criteria include FDA approval, evidence that a lot of providers do the procedures and the evidence that the procedures have proven effective. On the other hand, it is possible for Category III to be eliminated if they are not used by the provider.

As mentioned before, the American Medical Association or AMA shares CPT codes every year. The codes in Category III might be revised and there might be some new ones. Everything will usually be shared on its official website. However, the Category III deletions will be posted every year with the full set of the temporary codes.

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