Current Procedural Terminology (CPT) Guidelines

Current Procedural Terminology (CPT) Guidelines

Surgery

Surgery has the most number of CPT codes for any category. The guidelines cover topics that can be complicated. One guideline tells users how to combine some of these codes with E&M codes when necessary. Another says how to determine which charges can and cannot be billed together. A third explains the differences between diagnostic and therapeutic services.

Pathology

Radiology

Medicine

Anesthesia

The medicine area of the CPT manual is the most diverse as far as services are concerned, but the guidelines for this department are sparse. The main guideline is determining which service is actually being performed, as many of the CPT groups can seem similar based on wording, but are totally separate items. Most of the guidelines are contained within each subsection since this category contains so many different types of services.

Radiology encompasses scanning services, including obstetrical scanning, nuclear medicine and arteriograms.The guidelines show when these services are charged as separate procedures or as part of a more complicated procedure.

The section has one page of guidelines as a whole, and not many guidelines for specific groups of lab tests, either. The main guideline is for determining which tests must be bundled, which means billed under one CPT number instead of multiple numbers for multiple tests. The secondary guideline is determining which lab test is primary when certain groups of tests are performed.

The anesthesia guidelines are short because there aren't a lot of anesthesia charges. These CPT codes address either which part of the body required anesthesia or services that might have required a different level of anesthesia, such as treating burns. The guidelines concern reporting how long the anesthesia was given, the types of anesthesia and the types of procedures.

Evaluation and management

Evaluation and management codes are also known as E&M codes. These codes are used to indicate who is seeing the patient and what level of care the patient is getting. The codes in this category cover doctor's offices, clinics, inpatient visits and emergency room visit charges. The AMA guidelines in this category address things such as definitions between new and existing patients, levels of complaints and services, a patient's history with that physician and examination times.

Guidelines

CPT Guidelines are presented at the beginning of each section. These guidelines define items that are necessary to appropriately interpret and report the procedures and services contained in that section.