As noted by the American Medical Association (AMA), CPT is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. In order to navigate the CPT system and assign codes correctly, coders must be proficient in a number of key areas. Additionally, becoming familiar with the layout and structure of the CPT manual makes the coding process less intimidating and time consuming.
Coding Tools
Medical terminology, medical abbreviations, and anatomy and physiology play a big role within the coding process. Review medical dictionaries, anatomy and physiology handbooks or charts, “The Merck Manual of Diagnosis and Therapy” and coding reference books to gain an understanding of medical procedure codes.
CPT Design
The CPT system/manual is comprised of three categories (Category I, Category II and Category III), each of which contains: section headings (parts), subsections, subcategories, guidelines, symbols, colons & semi-colons, modifiers, appendices, indices, supplementary codes and examples.
Knowing the function, divisions, criterion and numbers surrounding each category allows you to locate the codes faster and easier. As noted in the American Health Information Management Association’s “Basic CPT/HCPCS Coding” literature, the category codes are further broken down into subsections and subcategories according to the type of service provided and the body system or disorder involved.
Categories, Subcategories and Numbers
CPT categories contain sections and subsections with a set of numbers used to identify the precise procedure or service.
For example, Category I CPT codes are divided into the sections: Evaluation and Management (99201-99499), Anesthesiology (00100–01999, 99100-99140), Surgery (10021-69990), Radiology (70010-79999), Pathology and Laboratory (80048-89356) and Medicine (90281-99199, 99500-99602).
Each section is further divided into subsections containing numbers; for classification. As illustrated in “An Introduction to CPT Coding,” from the College of American Pathologists, the subsections for Pathology and Laboratory are as follows: Infectious Agent: Detection of Antibodies (86602-86804), Molecular Diagnostics (83890-83912), Chemistry (82000-84999), Urinalysis (81000-81099), Consultations (80500-80502), Evocative/Suppression Testing (80400-80440), Therapeutic Drug Assays (80150-80299), Drug Testing (80100-80103) and Organ or Disease Panels (80048-80076).
Regulatory Considerations
All codes comply with specific guidelines, standards and laws. Organizations including the American Medical Association (AMA), Center for Medicare and Medicaid Services (CMS), and Institute for Safe Medication Practices (ISMP) work to ensure that all regulations are being met.
