It is vitally important that healthcare professionals and medical personnel keep up to date on all changes to the CPT Code. The CPT code is the current procedural terminology code set and is administered by the American Medical Association (AMA). The AMA appoints a committee known as the CPT Editorial Board to manage it, which is used by a variety of health care specialties to make the communication of medical terms consistent and uniform. It enables patients, physicians, organizations, and payers to communicate clearly and consistently regarding treatments.
Code changes published in new editions that are available annually. These new additions come out every year in October. There are standard and professional editions of the CPT code. Unlike the ICD-9 and ICD-10 code sets, the CPT set does not refer to the diagnosis of conditions but to the treatments and services used by medical professionals in the treatment of their patients. While ICD code sets have some codes for this purpose, they are not used in outpatient settings, whereas CPT codes are. The CPT code set is known as the Level One Health Care Procedure Coding System and is identified as such by the Centers for Medicare & Medicaid Services and is therefore very important to all professionals.
The code set is divided into several different categories. Category I consists of codes used for evaluation and management, anesthesia, surgery, radiology, pathology and laboratory, and medicine. Each of these subsections is broken down in a logical and intuitive way so that professionals in their respective fields can identify what type of code is being used. For example, codes for evaluation and management range from 99201 to 99499. Codes for anesthesia are divided into two groups, 00100 to 01999 and 99100 to 99150. Those for radiology range from 70010 to 79999. Category II codes are related to composite measures, patient history, physical examinations, screening processes, outcomes, preventive interventions, follow-up, patient safety, and structural measures. Category III codes are reserved for emerging technologies.
While the CPT code set should be used by nearly all insurance (health care) payment systems, as well as most medical office management solutions, it is copyrighted intellectual property of the Medical Association American, as determined by the case Practice Management v. American Medical Association. Even the Centers for Medicare & Medicaid Services (CMS) require the use of the codes, as do practical applications of the Health Insurance Portability and Accountability Act (HIPAA). Although the codes appear in the Federal Register, the AMA’s copyright law requires most organizations, professionals, and facilities that use the code to pay fees for the licenses necessary to access it. However, there are limited search capabilities related to the code available on the American Medical Association website. These searches are not intended for commercial organizations, only for individual and personal use. Changes to the CPT Code are also announced on the website, in abbreviated form.