The document provides an overview of CPT coding, including the history and organization of CPT codes, mandated reporting of CPT codes, non-reportable services, the six sections of CPT codes, and symbols and notes used in CPT coding. It describes the structure of CPT codes including sections, subsections, categories, and subcategories, and discusses unlisted procedures and services. The document aims to introduce healthcare providers to the CPT coding system.

1. Introduction to CPT Coding

2. WHAT ARE WE DOING HERE?
 Coding Systems….how many?
 What are the differences?
 Who uses what?
 ……our focus for AHMS 160

3. History of CPT
 1966
 Published by AMA
 1970
 Five-digit codes
 1983
 Adopted as part of HCPCS
(continued)

4. History of CPT
 1986
 Omnibus Budget Reconciliation Act (OBRA)
 1996
 HIPAA
 2004
 MMA

5. CPT Mandated Reporting
 Home health care and hospice agencies
 Outpatient hospital departments
 Physicians who are employees of health care facility
 Physicians who see patients in their offices or clinics and
in patients’ homes

6. CPT Mandated Reporting
 Home health care and hospice agencies
 Outpatient hospital departments
 Physicians who are employees of health care facility
 Physicians who see patients in their offices or clinics and
in patients’ homes

7. Non-Reportable Services
 Considered integral to procedure
 No separate code reported

8. Examples of Non-Reportable Services
 Administering sedatives
 Cleansing, shaving, and prepping of skin
 Draping and positioning of patient
 Irrigating wound
 Inserting and removing drains

9. CPT Categories
 Category I codes
 Procedures and services
 Category II codes
 Performance measures
 Category III codes
 Emerging technology

10. Organization of CPT
 Six sections
 Evaluation and Management (E/M) (99201–99499)
 Anesthesia (00100–01999, 99100–99140)
 Surgery (10021–69990)
 Radiology (70010–79999)
 Pathology and Laboratory (80048–89398)
 Medicine (90281–99199, 99500–99607)

11. CPT Index
 Alphabetic main terms
 Boldfaced
 Represent procedures or services, organs, anatomic
sites, conditions, eponyms, or abbreviations
 Subterms indented below

12. Selection from CPT Index
Current Procedural Terminology © 2010 American Medical Association. All rights
reserved.

13. CPT Index
 Organization
 Procedures or services (e.g., endoscopy)
 Organs or other anatomic sites (e.g., elbow)
 Conditions (e.g., wound)
 Synonyms (e.g., finger joint or intercarpal joint)
 Eponyms (e.g., Whitman procedure)
 Abbreviations (e.g., MRI)
(continued)

14. CPT Index
 Boldfaced type
 Main terms, categories, subcategories, and code numbers
 Italicized type
 Cross-reference terms (e.g., see)
 Directs coders to index entry under which codes are listed

15. Appendices
 Appendix A
 List of modifiers and descriptions
 Appendix B
 Annual CPT coding additions, deletions, and revisions
 Appendix C
 Clinical examples for codes found in E/M section
(continued)

16. Appendices
 Appendix D
 List of add-on codes
 Identified with plus symbol (+)
 Appendix E
 List of codes exempt from modifier -51
 Appendix F
 List of codes exempt from modifier -63
(continued)

17. Appendices
 Appendix G
 Summary of CPT codes identified with bull’s eye symbol
 Codes that include Moderate (Conscious) Sedation (MCS)
(continued)

18. Appendices
 Appendix H
 *Removed from CPT; Alphabetical Listing is available from
the AMA web site: www.ama-assn.org/go/cpt
 Appendix I
 Genetic testing modifiers
(continued)

19. Appendices
 Appendix J
 Electrodiagnostic medicine listing of sensory, motor, and
mixed nerves
 Appendix K
 List of codes pending Food and Drug Administration (FDA)
approval
(continued)

20. Appendices
 Appendix L
 List of vascular families
 Appendix M
 List of deleted CPT codes and descriptions with crosswalk
to new CPT codes

21. CPT Symbols
 Bullet located to the left of code identifies new procedures
and services
 Triangle located to the left of code identifies revision of
code description
 Horizontal triangle symbols surround revised guidelines
and notes
(continued)

22. CPT SYMBOLS
 Plus identifies add-on codes for procedures commonly, but
not always, performed at the same time and by the same
surgeon as the primary procedure (+)

23. CPT Symbols
 Circle with slash identifies forbidden or prohibited codes
exempt from modifier -51
 Bull’s eye identifies procedure that includes MCS
 Flash identifies codes that classify products pending FDA
approval
(continued)

24. CPT Symbols
Symbol CPT Entry
Use of ; 11000 Debridement of extensive eczematous
semicolon or infected skin; up to 10% of body
surface
Use of plus + 11001 Each additional 10% of body surface
symbol (List separately in addition to code for
primary procedure)
Use of -51 17004 Destruction (e.g., laser surgery,
modifier electrosurgery, cryosurgery,
exemption chemosurgery, surgical curettement),
symbol premalignant lesions (e.g., actinic
keratoses), 15 or more lesions
Use of 33206 Insertion or replacement of permanent
bull’s eye pacemaker with transvenous
Current Procedural Terminology © 2010 American Medical Association. All rights reserved.
symbol electrode(s); atrial

25. CPT Guidelines
 Define terms and explain assignment of codes for
procedure and services
 Located at beginning of each CPT section
 Guidelines from one CPT section do not apply to another
CPT section
 Should be reviewed before assigning code

26. Sections, Subsections, Categories, and
Subcategories
 Six sections subdivided into the following:
 Subsections
 Categories
 Subcategories
 Guidelines at beginning of each subsection
(continued)

27. Sections, Subsections, Categories, and
Subcategories
Selection from CPT that illustrates sections, subsections, categories,
subcategories, notes, and descriptive qualifiers
Current Procedural Terminology © 2010 American Medical Association. All
rights reserved.

28. Unlisted Procedures and Services
 Unlisted procedure or unlisted service
 Assigned when provider performs procedure or service for
which there is no CPT code
 Special report must accompany claim to provide more
information
 e.g., copy of procedure report

29. Sections, Subsections, Categories, and
Subcategories
 Notes, parenthetical notes, and descriptive qualifiers in
each section, subsection, category, and subcategory

30. Instructional Notes
 Blocked un-indented note
 Indented parenthetical note
 Parenthetical note

31. Descriptive Qualifiers
 Terms that clarify assignment of CPT code
 Can you find the descriptive qualifier in code 35188?
That’s right; head and neck qualifies the procedure as
opposed to the same procedure involving the thorax and
abdomen or extremities.