The categories in the Current Procedural Terminology code set is Category I codes, which is where the most common set of codes are in the main body of CPT, with five digits and no decimals (Valerius et al, 2012). To help one better understand this section of the CPT is to remember that Category I is this most used in healthcare facilities to describe a procedure or service. Furthermore, the procedures or services covered in Category I are in and out patient office visits, which is used for evaluation and management of a new patient(Valerius et al, 2012). Also procedures done with anesthesia on the upper posterior abdominal wall, as well as the removal of indwelling tunneled pleural catheter with cuff; radiologic examination, ACTH stimulation, and Intravenous infusion (Valerius et al, 2012).
For example, a 30- year-old woman came into the office for an initial inpatient consultation (99251), which can be found under the Evaluation and Management section of the CPT manual codes 99201-99499(Valerius et al, 2012). Remembering that these codes have no letters in them, and they contain five numbers can be helpful with distinguishing the difference between the other categories.
In this part of the CPT manual, one can view Category II as optional codes (Valerius et al, 2012). The codes in Category II are supplemental tracking codes used for performance and measurements. These codes are not paid by insurance companies, but the codes assist with the collection of data on the quality of care in the coding process, which can help with providing the best quality care to the patients and documentation (Valerius et al, 2012). Category II codes have alphabetic characters for the fifth digit (Valerius et al, 2012).
Some of the procedures and services covered in this section are low risk or recurrence, prostate cancer, and tobacco use counseling. For example, a 65- year-old man came into the office with recurring polyps, which can indicate benign or malignant tumors. The codes maybe found under 3271F in the Category II section of the CPT manual. Remembering that these codes have an F at the end of the numbers can be helpful with understanding the difference between the other categories.
In this section on the CPT manual, Category III codes are viewed as temporary (Valerius et al, 2012). These codes are temporary for new and emerging technologies, which can become a permanent part of Category I if it is proven to be effective, and is commonly performed (Valerius et al, 2012). The codes have five characters, with four digits followed by the letter T (Valerius et al, 2012). A procedure covered in this section is a high dose rate electronic brachytherapy, per fraction (Valerius et al, 2012). For example, a 40- year-old woman has a history of breast cancer. The physician order a Brachytherapy, which is a radiation device placed within or close to a target site. This procedure maybe found under the code 0182T. Remembering that these codes have a T at the end of the numbers can be helpful with understanding the difference between the other categories.
Valerius, J. D., Bayes, N. L., Newby, C., & Blochowiak, A. L. (2012). Medical Insurance: An Integrated Claims Process Approach (6th ed.). New York, NY: McGraw-Hill.
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