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Current Procedural Terminology (CPT®)

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Current Procedural Terminology (CPT®) is a listing of descriptive terms and identifying codes for reporting medical services and procedures. The purpose of CPT is to provide a uniform language that accurately describes medical, surgical, and diagnostic services, and thereby serves as an effective means for reliable nationwide communication among physicians, and other healthcare providers, patients, and third parties. CPT was developed by the American Medical Association (AMA) in 1966.

CPT coding is like a language for those who work in the medical field. A CPT code is a string of numbers, usually five, that indicate a service or procedure. The AMA approves all CPT codes and updates them annually. CPT coding is an intricate and very specific procedure.

CPT descriptive terms and identifying codes currently serve a wide variety of important functions. This system of terminology is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT is also used for administrative management purposes such as claims processing and developing guidelines for medical care review.

The uniform language is likewise applicable to medical education and research by providing a useful basis for local, regional, and national utilization comparisons.

The American Medical Association (AMA) first developed and published CPT in 1966. The first edition helped encourage the use of standard terms and descriptors to document procedures in the medical record; helped communicate accurate information on procedures and services to agencies concerned with insurance claims; provided the basis for a computer oriented system to evaluate operative procedures; and contributed basic information for actuarial and statistical purposes.

The first edition of CPT contained primarily surgical procedures, with limited sections on medicine, radiology, and laboratory procedures. The second edition was published in 1970, and presented an expanded system of terms and codes to designate diagnostic and therapeutic procedures in surgery, medicine, and the specialities. At that time, a five-digit coding system was introduced, replacing the former four-digit classification. Another significant change was a listing of procedures relating to internal medicine.

In the mid to late 1970s, the third and fourth editions of CPT were introduced. The fourth edition, published in 1977, represented significant updates in medical technology and a system of periodic updating was introduced to keep pace with the rapidly changing medical environment. In 1983, CPT was adopted as part of the Centers for Medicare and Medicaid Services (CMS), formerly Health Care Financing Administration's (HCFA), Healthcare Common Procedure Coding System (HCPCS). With this adoption, CMS mandated the use of HCPCS to report services for Part B of the Medicare Program. In October 1986, CMS also required state Medicaid agencies to use HCPCS in the Medicaid Management Information System. In July 1987, as part of the Omnibus Budget Reconciliation Act, CMS mandated the use of CPT for reporting outpatient hospital surgical procedures.
Today, in addition to use in federal programs (Medicare and Medicaid), CPT is used extensively throughout the United States as the preferred system of coding and describing health care services.

Knowledge of CPT coding can be put to use in medical offices – both in records and billing, hospital records departments, and health insurance companies. Being able to differentiate between specific CPT coding requirements for different insurance providers is one area in which CPT coders are able to help both patients and doctors. Without the proper CPT coding, many insurance claims are denied.

It is divided into three sections:

* Category I CPT Code(s)
* Category II CPT Code(s) – Performance Measurement
* Category III CPT Code(s) – Emerging Technology

It currently is used as Level 1 of the Health Care Procedure Coding System.

For further information about CPT, please visit their website.

 

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