Category III codes are important for maintaining the integrity of the CPT process, since they permit a means to track the use of new technology, before such technology is widely adopted. The use of similar Category I codes for new technology is clearly discouraged by the CPT rules; in fact, the rules, in their strictest sense, actually prohibit this. The other alternative is the use of unlisted procedure Category I code, but when physicians do this, it becomes impossible to measure the actual usage of a specific technology.
Thus, the preferred route for coding new technology is the development and application of a Category III code. CPT has evolved since its introduction, and the AMA has a specific process for monitoring the integrity of CPT and adapting for changes in physician practice and medical technology. Posted on December 11, In general, such codes report services whose effectiveness is well supported in the medical literature and whose constituent parts have received clearance from the US Food and Drug Administration FDA.
The concept is that the use of these codes should facilitate the administration of quality improvement projects by allowing for standardized reporting that captures the performance or non-performance of services designated as subject to process improvement efforts. The process of generating a new code or revising an existing one usually begins with a query to the AMA CPT coding office.
Requests for changes may come from physicians, medical societies, manufacturers, billing services, hospital coders, or any other interested party. Commonly pronounced Hick-Picks. This system is a uniform method for health care providers and medical suppliers to report professional services, procedures, and supplies. The CMS developed this system in to:.
The CPT Book does not contain all the codes needed to report medical services and supplies, and this prompted the Centers for Medicare and Medicaid Services or CMS to develop the second level of codes. The codes begin with a single letter A through V followed by four numeric digits.
They are grouped by the type of service or supply they represent. The codes are updated annually. The third level contains codes assigned and maintained by individual state Medicare carriers.
Like Level II, these codes begin with a letter W through Z followed by four numeric digits, but the most notable difference is that these codes are not common to all carriers. Please refer to the eBook for a complete breakdown of the subfields used in each of the code fields. Each of these fields has its own particular guidelines when it comes to use. For example, the Surgery section has a guideline for how to report extra materials used such as sterile trays or drugs and how to report follow-up care in the case of surgical procedures.
If a procedure is indented below another code, the indented procedure is an important or noteworthy variation on the above procedure, and would replace the first code. The first, which comes before the semicolon, is the general procedure. If we look in the CPT manual, we find the code below CPT codes also have a number of modifiers.
These modifiers are two-digit additions to the CPT code that describe certain important facets of the procedure, like whether the procedure was bilateral or was one of multiple procedures performed at the same time.
CPT modifiers are relatively straightforward, but are very important for coding accurately. For now, just recognize that the CPT code set has a number of instructions that inform the medical coder on how to best code the procedure performed. Remember that you always need to code to the highest level of specificity, and a miscoded procedure can be the difference between an accepted and rejected claim.
Each of these sections has its own subdivisions, which correspond to what type of procedure, or what part of the body, that particular procedure relates to. The sections are grouped numerically, and, aside from Evaluation and Management, are in numerical order. Certain codes have related procedures indented below them. These indented codes are important variations on the code above them, and denote different methods, outcomes, or approaches to the same procedure.
For example, the code for the elevation of a simple, extradural depressed skull fracture is The code for the elevation of a compound or comminuted, extradural depressed skull fracture is There are a few important CPT Modifiers, which provide additional information about the procedure performed. Some codes have instructions for coders below them.
These instructions are found in parentheses below the code, and they instruct the coder that there may be another, more accurate code to use.
These codes are five character-long, alphanumeric codes that provide additional information to the Category I codes.
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