February 23, 2024

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Staying Updated On CPT Code Changes

It’s of critical importance for health care professionals and medical personnel to remain up to date on all changes to the CPT Code. The CPT code is the Current Procedural Terminology code set, and it is managed by the American Medical Association (AMA). The AMA appoints a committee known as the CPT Editorial Panel to handle it, which is used by a variety of health care specialties to make communication of medical terms consistent and uniform. It allows patients, physicians, organizations, and payers to communicate clearly and consistently in regards to treatments.

Changes to the code released in new editions which are available annually. These new additions come out each 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 diagnosis of conditions but rather to the treatments and services used by medical professionals in the treatment of their patients. While the ICD code sets do have some codes for this purpose, they are not utilized in outpatient settings, while CPT codes are. The CPT code set is known as level one of the health care procedure coding system, and identified as such by the Centers for Medicare and Medicaid Services, and thus is very important for all practitioners.

The code set is divided in a number of 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 manner so that professionals in their respective fields can identify which type of code is being used. For example, the codes for evaluation and management range from 99201 to 99499. The codes for anesthesia fall 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 exams, screening processes, results, preventative interventions, follow-ups, patient safety, and structural measures. Category III codes are reserved for emerging technologies.

While the CPT code set is required to be used by nearly all insurance (health care) payment systems as well as most medical practice management solutions, it is the copyrighted intellectual property of the American Medical Association, as determined by the case Practice Management versus American Medical Association. Even the Centers for Medicare and Medicaid Services (CMS) requires 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 requires that most organizations, practitioners, and facilities that use the code pay fees for licenses required 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 use by commercial organizations, only for individual, personal use. CPT Code changes are also announced on the website, in abbreviated form.