CPT codes fall into three categories. We have earlier seen a brief description of these categories. Let’s now have a closer look at them.
CPT codes – Category I
Category I CPT codes identify a procedure or service with the help of a five digit numeric CPT code. This category describes most of the procedures executed by healthcare providers. Category I CPT codes are further divided into six sections based on the field of health care they belong to.
CPT codes are almost grouped numerically except the Evaluation and Management (E&M) codes. Each of the code fields contain sub fields that shows how the corresponding section applies to a particular field of healthcare. For e.g. the surgery section is organized by the human body parts on which the surgery would be performed. Each field has its own guidelines for using them. For instance, the surgery section has guideline for reporting extra materials used and follow-up care.
Much of the CPT codes are arranged by indentation. When a procedure is indented below another code, the indented procedure is an important variation of the above procedure and would substitute the above code. For instance, 62000 is the code for the elevation of a simple, extradural depressed skull fracture and 62005 is the code for the elevation of a compound, extradural depressed skull fracture.
There are certain modifiers in CPT codes which are two-digit descriptor fields that provide some additional information about the procedure.
Some codes also have instructions below them in parentheses which tell the medical coder how to code the procedure performed in the best way.
CPT codes – Category II
Category II CPT codes provide additional information to the Category I codes with the help of five character-long, alphanumeric codes. These codes have four digits, followed by the character F. They are optional but provide important information that is used for performance management and future patient care.
For example, if a doctor records a patient’s Body Mass Index (BMI) during a routine checkup, Category II code 3008F, “Body Mass Index (BMI), documented” can be used.
These codes cannot replace Category I or Category III codes but they provide extra information. These are divided into numerical fields which identify certain elements of patient care
Although Category II CPT codes are not used much but still they are an important part of the CPT code set.
CPT codes – Category III
Category III CPT codes were first established in 2001. Category III CPT codes are temporary codes representing new, emerging or experimental services, technology, and procedures. They have been developed for collecting data and assessing new services and procedures. Category III codes helps medical coders to code more specifically and they also help health facilities and government agencies to track the effectiveness of new and emerging medical techniques.
These are five digit codes, comprised of four digits and a terminal letter T. For example, the code for “Implantation of a ventricular assist device, extracorporeal, percutaneous trans septal access,
single or dual cannulation” is 0048T.
The CPT editorial panel decides if a code should become a Category I code. This panel approves Category III codes for five years, during which the service or procedure may be more widely used and have necessary documentary evidence to become Category I code. If this is not met, the code may be given another five-year extension. Mostly, if the code does not become Category I by this time, the code is abolished.