Cpt Codes

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CPT codes are broken up into 3 categories, I, II, and III. The best way to remember the three categories would be with the use of buzzwords for example: Category I or common, Category II or optional, and Category III or provisional.

Category I CPT Codes are for regular codes, or common procedures, used to report the physician’s service to the patient. These codes are five digits long and have no decimal. Common codes listed within Category I are broken up into six categories: evaluation and management, anesthesia, surgery, radiology, pathology and laboratory, and medicines. Category I codes also have a descriptor, or a brief explanation of the procedure the patient received, and are used by all types of physicians. For example: 99204 Office visit for evaluation and management of a new patient (Medical Insurance, 2008), 86900 Blood typing, ABO, and 76498 Unlisted diagnostic radiographic procedures ("Advance", 2011).

Category II CPT Codes or optional codes are used to monitor a patient’s health improvement towards a specific medical goal. They are intended to assist with data collection about the quality of care rendered by coding certain services and test results that support nationally established performance measures and that have an evidence base as contributing to quality patient care ("Meditec", 2002-2012). Category II codes also help to reduce the time spent reviewing the patients chart to verify the measures performed. Services to aid in the patient’s efforts to quit smoking would be listed under the optional CPT codes or Category II. Services received under Category II are usually not covered by the insurance company. Category II codes, or optional codes will have four digits followed by an alphabetic character. For example: 0004F Tobacco use cessation intervention, counseling (Medical Insurance, 2008), 0001F-0015F Composite Measures, and 6005F-6045F Patient Safety ("Advance", 2011).

Category III CPT Codes or provisional codes are...
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