How to Use the CPT Book

CPT Coding Principles

I. CPT-4 represents the “WHAT” was done to the patient (procedure)

Ex. Procedure Code - 93010 (EKG)

Organization of the CPT Manual (6 major sections):

  • Evaluation and Management (99201 – 99499)
  • Anesthesiology (00100 – 01999, 99100-99140)
  • Surgery (10040 – 69990)
  • Radiology (70010 – 79999)
  • Pathology and Laboratory (80049 – 89399)
  • Medicine (90281 – 99199)

Navigating around the CPT Manual:

  • Find desired term (procedure, organ, condition, synonyms) in Alphabetical Index in the back of the manual.
  • Look up the procedure code in the Tabular Index which was found in the Alphabetical Index to find the exact procedure code that applies to the procedure.
  • The guidelines at the beginning of a section of the CPT Manual’s Tabular Index must be carefully read to make sure the correct code is applied. This is critical to using CPT correctly.

CPT Symbols:

▲ Description has been substantially altered

● Appears the first year the code is added to the manual

+ Add on codes that never stand alone; code primary procedure first, then add on code.

►◄ New or revised text

Ө Codes exempt from the modifier, but that do not have designated add-on procedures or services

Format of the CPT-4:

  • Developed as a stand-alone description of the procedures
  • To conserve space, some are not printed in their entirety but refer back to a common portion listed in a preceding entry**

Example:

25100 arthrotomy, wrist joint; for biopsy

25105 for synovectomy

25105 arthrotomy, wrist joint: for synovectomy

** commonly referred to as indented codes

Ten Steps to Basic CPT Coding

  1. Read the source document. Never assume.
  2. Using information in the record, analyze procedure statement provided by physician. Identify main term and modifying terms. If source document is unclear, always verify service performed with the physician.
  3. Locate main term in the CPT index.
  4. Look for sub-terms indented below the main term.
  5. Jot down the tentative code range for each procedure.
  6. Locate each tentative code in the book.
  7. Read any instructional notes and watch for diagnoses or specific procedures within code descriptions.
  8. Verify that the code matches the procedure statement provided in the record.
  9. Assign a modifier if necessary.
  10. Assign the code.

Appendices:

Appendix A: Modifiers

Appendix B: Summary of additions, deletions and revisions

Appendix C: Update to short descriptor

Appendix D: Clinical examples supplement

Appendix E: Summary of add on codes

Appendix F: Summary of CPT codes exempt from modifier -51

II. Modifiers

  • Adding an appropriate modifier to a procedure code provides more complete information to the insurance company about the service performed.
  • Can affect the rate of reimbursement for the service.