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Medical terminologies

CPT: Current Procedural Terminology

CPT®
name Current Procedural Terminology
summary Nomenclature used to report medical procedures and services performed by physicians.

CPT is a registered trademark of the American Medical Association.

clinical focus Medical procedures and services
introduced 1966
current version Updates released annually.
developed by American Medical Association
features
  • The most recent version of CPT, CPT 2006, contains 8,568 codes and descriptors.
  • The AMA publishes CPT Principles of Coding, an educational primer covering the basic concepts of CPT coding
  • There are three categories of CPT codes.
    • "Category I codes are designated for services [or procedures] common in "contemporary medical practice and being performed by many physicians in clinical practice in multiple locations." For each, there is a five-digit code and a text descriptor."
    • Category II CPT Codes are docused on performance measurement: "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 use of tracking codes for performance measures will decrease the need for record abstraction and chart review, thus minimizing administrative burdens on physicians and survey costs for health plans."
    • "Category III CPT Codes deal with emerging technology. 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."
standards De facto standard
in use Adopted as a standard code set by Medicare and Medicaid soon after initial release. Later adopted by private insurance carriers and managed care organisations. The Health Care Financing Administration (HCFA) requires the use of CPT for reporting services to Medicare and Medicaid for reimbursement. In 2001, CPT was selected by the Department of Health and Human Services (HHS) as the standard code set for reporting health care services in electronic transactions.
access  bullet  Information on use of CPT® (AMA)
tools  bullet  CPT code search engine (AMA)
references

Rallins MC, Sperzel D, Beebe M, Mays E. Emergence of Health Information Technology Motivates the Evolution of CPT(R). AMIA Annu Symp Proc. 2006;:1185-6.

[PubMed]   []

" Health Information Technology (HIT) has been in the national spotlight since the Health Information Portability and Accountability Act (HIPAA) was enacted in 1996. HIPAA-mandated efforts initially involved the establishment of standards for electronic transactions, as well as standards for the security and privacy of health data. Current Procedural Terminology(R) (CPT), which is owned and copyrighted by the American Medical Association (AMA), was identified as an important standard for HIPAA transactions. As a result, it was designated as the national code set for physician and other health care professional services. Since the advent of HIPAA, HIT efforts have shifted in focus to building a national health information network with emphasis on patient safety and electronic health records. The envisioned health information infrastructure requires the use of uniform health information standards (both clinical and administrative) that are interoperable. Such interoperability requires that clinical and administrative code sets (such as SNOMED CT(R) and CPT respectively), be incorporated into EHR systems and mapped to allow information sharing. In its capacity as the HIPAA standard for procedures, CPT is primarily used for payment and administrative purposes. The reimbursement and administrative focus, while recognized as essential, has limited functionality in EHR systems unless it is linked to clinical data. Furthermore, the current flat file format of CPT, although ideal for developing printed material, is of limited use in developing healthcare software applications, mapping to other code sets, and supporting HIT initiatives. Development of CPT Data ModelIn an effort to meet the evolving needs of HIT, the existing CPT data file is undergoing significant enhancement and revision. The American Medical Association, in collaboration with Apelon, Inc., is developing a new CPT data model that facilitates interoperability. The new data model includes explicit hierarchical (vertical) relationships between CPT concepts. Its structure is based on the mathematical formalism of description logic, which allows automated classification of concepts within the hierarchy. "

Manchikanti L. CPT 2000: Interventional Pain Management Coding in the New Millennium. Pain Physician. 2000 Jan;3(1):73-85.

[PubMed]   []

" Current Procedural Terminology is a systematic listing and coding of procedures and services performed by physicians and other providers. The CPT is the most widely accepted nomenclature for the reporting of procedures by physicians and other providers for health-care services provided by the government, and private health-insurance programs. It is most widely accepted for claim processing, and for the development of guidelines for medical care review, and it provides the uniform language applicable to medical education, research, and utilization. The CPT 2000 includes a multitude of changes. Those of most important interest to interventional pain management specialists include neural blockade where the codes used in pain management have been totally revamped. The entire section of neural blockade codes has been substantially altered, either by deletion, modification, or addition of a new code. Various deleted codes include 62274 to 62279, 62288, 62289, 62298, and 64440 to 64445. The definitions for CPT codes 62273, 62280, 62281, 62282, 62287, 62291, 62350, 64622, 64623, and 72285 have been modified and changed. Multiple new codes not only include replacement codes for epidurals, but also creation of codes for sacroiliac-joint injection, sacroiliac-joint arthrography, percutaneous lysis of epidural adhesions, facet-joint injections at the cervical and thoracic levels, neurolytic facet-joint neural blockade for cervical and thoracic levels, transforaminal injection codes for cervical/thoracic and lumbar/sacral, epidurography and radiological examination. The several advantages and disadvantages of new codes and future directions in CPT coding are described. "

Manchikanti L, Singh V. Interventional pain management: evolving issues for 2003. Pain Physician. 2003 Jan;6(1):125-37.

[PubMed]   []

" The new millennium has seen the introduction of an array of new Current Procedural Terminology(R) (CPT) codes and the expansion of interventional techniques. Among the many issues of interest to physicians practicing interventional pain management in 2003 are CPT coding, correct coding issues, and utilization. The CPT developed and updated by the American Medical Association, is the most important and commonly used coding system for interventional pain physicians in the United States. A recent development in the CPT system has been to include Category I, Category II, and Category III CPT codes. Inclusion of a code in Category I is generally based on the procedure being consistent with contemporary medical practice and being performed by many physicians in clinical practice in multiple locations. In contrast, CPT Category III, also known as emerging technology codes, is a set of temporary codes for emerging technology, services, and procedures. There have been many new codes since 2000, along with changes in the definitions of the codes and vignettes. In order for the correct coding initiative to be effective, it is essential that the coding describes what actually transpires at each patient encounter. When multiple procedures are performed at the same session, the procedure and post-procedure work do not have to be repeated for each procedure, and, therefore, a comprehensive code describing the multiple services commonly performed together can be used. Thus, many activities which are integral to a procedure are considered as generic activities and are assumed to be included as acceptable medical/surgical practice and, while they couldn't be performed separately, they should not be considered as such when a code narrative is defined. Under this initiative, almost all interventional techniques are affected. The utilization of interventional techniques in the modern era is the final issue. Utilization has been increasing gradually. Thus, it is important for interventional pain physicians to understand the utilization patterns across the nation and for various techniques. This review will discuss the issues of CPT coding, correct coding, and utilization as they pertain to interventional techniques. "

contact

CPT Editorial Research and Development staff
The American Medical Association

links  bullet  CPT® (AMA)
acknowledgements
 
page history
Entry on OpenClinical (draft v0.1): 09 August 2006
Last main update: 09 August 2006

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