Overview of CPT-4 Coding

Introduction

Current Procedural Terminology (CPT) is a nomenclature (calling of names) used for reporting medical services and procedures. It is a communication tool that is used to describe medical, surgical, diagnostic services among health care professionals, patients and third party payers.  CPT was developed by the American Medical Association (AMA) and was first published in 1966. It consists of five digit codes and is part of the Health Care Common Procedure Coding System (HCPCS).

CPT was mandated, by the Centers for Medicare and Medicaid (CMS), in 1983 for use in reporting Medicare Part B services. HCPCS is required for Medicaid agencies and as part of the Omnibus Budget Reconciliation Act (OBRA), Centers for Medicare and Medicaid mandates that CPT codes be reported for outpatient hospital surgical procedures.  HIPAA named CPT and HCPCS as the procedure code set for physician services, physical and occupational therapy services, radiological services, clinical laboratory tests, other medical diagnostic procedures, hearing and vision services and transportation services, including ambulance services.

Objectives

Upon completion of this module, the student will be able to:
  • Define medical coding
  • Identify the purpose and various uses of Current Procedural Terminology coding
  • Explain CPT format
  • Describe the contents of CPT and HCPCS coding
  • Interpret conventions and characteristics of CPT
  • Locate main terms and subterms in the CPT index

Readings & Resources

Required textbook reading:  Kuehn, Lynn.  Procedural Coding and Reimbursement for Physician Services:  Applying Current Procedural Terminology and HCPCS.  AHIMA Press. 2012 edition. Chapter 1
 
Required textbook reading:  Smith, Gail.  Basic Current Procedural Terminology and HCPCS Coding.  AHIMA Press.  Most current edition - Chapter 1 & 2
 
AMA, Current Procedural Terminology (CPT) 2013. Professional Edition. HCPCS
 
Centers for Medicare and Medicaid Services

Journal of AHIMA

CPT Assistant

CPT Category III Codes

CMS Manuals

Assignments and Activities