The Current Procedural Terminology (CPT) system is evolving with the ultimate goal of fair payment that considers procedural/device intensity, time, and postoperative care.
Reviewed by Cynthia Mattox, MD
As surgeons are aware, the Current Procedural Terminology (CPT) system—maintained/copyrighted by the American Medical Association—comprises five-digit codes that define all physician services ranging from testing codes to examination visit codes to surgical codes. Of these, the Category I codes are the main codes for which payments are easily made, according to Cynthia Mattox, MD.
She explained that there are criteria to determine if physicians can have a Category I code, which mandates use of an FDA-approved drug if a Category I code is involved and the surgery must be performed extensively countrywide by multiple providers, and have well-documented reported efficacy in the peer-reviewed literature. CPT codes are used in conjunction with ICD-9-CM or ICD-10-CM numerical diagnostic coding during the electronic medical billing process.
“These criteria have recently been stepped up and the bar is higher,” said Dr. Mattox, who spoke on behalf of David Glasser, MD, at the recent American Glaucoma Society annual meeting and is immediate past president of the organization.
Cynthia Mattox, MD
E: [email protected]
Dr. Mattox has no financial interest in any material presented in this report.