CPT® Codes

The Current Procedural Terminology (CPT), published annually by the American Medical Association, provides information on the correct use of codes. A current copy of the CPT is required in order to acquire the knowledge necessary to properly report procedures provided by physicians and non-physician practitioners. The most up-to-date information and is always current in AAPC Coder. You have access CPT at your fingertips. If you have internet access and your laptop, tablet, or smartphone --- are ready to code.

To code properly, it is important to have both an awareness and understanding of the support structure underlying the CPT coding system. CPT codes do not exist by themselves. They are supported by a system of rules, symbols, notations, and formatting. AAPC Coder uses symbols and alerts that make this easier than coding from books. Coders code an average of 33% faster using AAPC Coder because of this and other features.

The CPT itself is a part of a complex coding system.

• CPT is part of Level I coding and is primarily for procedures provided to patients. It is comprised of CPT (Current Procedural Terminology), a numeric coding system maintained by the American Medical Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These health care professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. Decisions regarding the addition, deletion, or revision of CPT codes are made by the AMA. The CPT codes are republished and updated annually by the AMA. Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.
• In October of 2003, the Secretary of HHS delegated authority under the HIPAA legislation to CMS to maintain and distribute HCPCS Level II Codes. As stated in 42 CFR Sec. 414.40 (a) CMS establishes uniform national definitions of services, codes to represent services, and payment modifiers to the codes. Within CMS there is a CMS HCPCS Workgroup which is an internal workgroup comprised of representatives of the major components of CMS, as well as other consultants from pertinent Federal agencies. Prior to December 31, 2003, Level III HCPCS were developed and used by Medicaid State agencies, Medicare contractors, and private insurers in their specific programs or local areas of jurisdiction. For purposes of Medicare, level III codes were also referred to as local codes. Local codes were established when an insurer preferred that suppliers use a local code to identify a service, for which there is no level I or level II code, rather than use a "miscellaneous or not otherwise classified code." The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required CMS to adopt standards for coding systems that are used for reporting health care transactions. We published, in the Federal Register on August 17, 2000 (65 FR 50312), regulations to implement this part of the HIPAA legislation. These regulations provided for the elimination of level III local codes by October 2002, at which time, the level I and level II code sets could be used. The elimination of local codes was postponed, as a result of section 532(a) of BIPA, which continued the use of local codes through December 31, 2003.
• CPT is a standardized system of 5-digit codes and descriptive terms used to report the medical procedures and services performed by physicians. It was developed by the American Medical Association (AMA) and is updated annually.
• The first edition of CPT was developed and published by the AMA in 1966. The 1966 manual contained four digit codes with brief descriptions that do not really correlate to today’s CPT.
• The second edition, published in 1970, began to approximate the current coding manual. It contained guidelines to various sections, five digit codes, and two modifiers. A third edition was published in 1973, adding more modifiers, starred procedures, and an appendix of deleted codes. The fourth edition appeared in 1977. Every year there are significant revisions that affect coding and billing. AAPC Coder makes it easier for coders to stay on top of these changes. It makes it easy for auditors to reference retrospective coding audits with the correct codes for the year under review.
• CPT is still in its fourth edition. The AMA continues to update it annually, with 400-700 changes that are effective the beginning of each year. The AMA is planning the next edition, CPT-5, however; in the meantime, there will be deletions, additions, and changes to the narratives in CPT-4. It is extremely important to use the most current edition of the manual for accurate and complete coding. CPT is also known as "Level I HCPCS", it does not include codes needed to report medical items or services that are regularly billed by suppliers other than physicians.
• The AMA released CPT Category II and III codes for implementation January 1, 2004. Category II codes are supplemental tracking codes used for performance measurement. These codes are intended to facilitate data collection about quality of care by coding certain services and test results that support performance measures and have been decided on as contributing to good patient care. Category III codes are temporary codes for emerging technology, services, and procedures. Category II codes are reviewed by the Performance Measures Advisory Group (PMAG), an advisory body to the CPT Editorial Panel and the CPT/HCPAC Advisory Committee. The PMAG is composed of performance measurement experts representing the Agency for Healthcare Research and Quality (AHRQ), the American Medical Association (AMA), the Centers for Medicare and Medicaid Services (CMS), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA) and the Physician Consortium for Performance Improvement. The PMAG may seek additional expertise and/or input from other national health care organizations, as necessary, for the development of Category II codes. These may include national medical specialty societies, other national health care professional associations, accrediting bodies and federal regulatory agencies. Category II codes make use of an alphabetical character as the 5th character in the string (i.e., 4 digits followed by the letter F). These digits are not intended to reflect the placement of the code in the regular (Category I) part of the CPT codebook. Appendix H in CPT section contains information about performance measurement exclusion of modifiers, measures, and the measures' source(s). These codes are used in Value Based Payment programs like QPP, PQRS, MACRA, MIPS, and Advanced APMs. CPT II codes are billed in the procedure code field, just as CPT Category I codes are billed. CPT II codes describe clinical components usually included in evaluation and management or clinical services and are not associated with any relative value. Therefore, CPT II codes are billed with a $0.00 billable charge amount.
• Coding in AAPC Coder makes it easy for you navigate the codes. Each section of the CPT provides special instructions for using the codes in that section. Before selecting a code, a coder must look for these instructions – These guidelines are in the section guidelines, at the beginning of the subsections, headings and/or subheadings, and above and/or below the code itself. AAPC Coder makes the easy by bringing them to the coder’s attention real-time as they are coding.