The language of medicine today
The CPT® coding system offers doctors across the country a uniform process for coding medical services that streamlines reporting and increases accuracy and efficiency. For more than five decades, physicians and other health care professionals have relied on CPT to communicate with colleagues, patients, hospitals and insurers about the procedures they have performed.
CPT descriptive terms and identifying codes currently serve a wide variety of important functions. This system of terminology is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT is also used for administrative management purposes such as claims processing and developing guidelines for medical care review.
The uniform language is also applicable to medical education and research by providing a useful basis for local, regional and national utilization comparisons.
The CPT® Editorial Panel
The CPT® Editorial Panel is tasked with ensuring that CPT codes remain up to date and reflect the latest medical care provided to patients. In order to do this, the Panel maintains an open process and convenes meetings three times per year to solicit the direct input of practicing physicians, medical device manufacturers, developers of the latest diagnostic tests and advisors from over 100 societies representing physicians and other qualified health care professionals.
The group has the final authority to decide on assigning a code’s category, whether it is a Category I or Category III.
The CPT Editorial Panel process
The CPT® Editorial Panel follows the CPT Editorial Panel (Panel) process to maintain the CPT code set and is authorized by the AMA Board of Trustees to revise, update or modify CPT codes, descriptors, rules and guidelines. The Panel process is open and transparent, involving the direct input of practicing physicians, medical device manufacturers, developers of the latest diagnostic tests, and advisors from over 100 societies representing physicians and other qualified health care professionals.
Together with this spectrum of contributors, the Panel ensures that the latest procedures are reflected accurately in the CPT code set. The process is designed to adapt to technological advances by updating the CPT code set and related content annually with changes taking effect on Jan. 1 of each year. Parts of the CPT code set are updated on a quarterly basis in dynamic areas.
Makeup of CPT Editorial Panel
The Panel is representative of all medical professionals, with 12 of its 21 members appointed by the national medical specialty societies. In addition to the specialty seats, the Panel includes a seat for the Panel chair, vice chair, two seats for members of the CPT Health Care Professionals Advisory Committee, as well as representatives from these organizations:
- One seat for the Blue Cross and Blue Shield Association
- One seat for the America's Health Insurance Plans
- One seat for the American Hospital Association
- One seat for an at-large organizational member
- One seat for an umbrella organization that represents private health care insurers
The AMA Board of Trustees selects all CPT Editorial Panel members. The Panel chair and vice-chair are selected by the AMA Board directly. Specialty societies and other qualifying at-large or umbrella payer organizations nominate individuals to the Panel, who must also be approved by the AMA Board. The remainder of the seats are nominated within their organizations, but also must be approved by the AMA Board.
The Centers for Medicare & Medicaid Services (CMS), Centers for Disease Control and Prevention (CDC), and the U.S. Food and Drug Administration (FDA) each currently have one non-voting liaison to the CPT Editorial Panel. These individuals, while not voting, still have significant input into the Panel review process and are able to submit comments like all other Panel participants.
Five members of the Panel serve as its executive committee. The executive committee includes the Panel chair, vice chair and three Panel members at-large, as elected by the entire Panel. One of the three members at-large of the executive committee must be a third-party payer representative.
Current Panel members
- Christopher Jagmin, MD (chair)
- Barbara Levy, MD (vice chair)
- Sarah Abshier, DPM
- J. Mark Bailey, DO, PhD
- Leo Bronston, DC
- Aaron Bossler, MD, PhD
- Joseph Cheng, MD
- Samuel "Le" Church, MD
- Scott Collins, MD
- Richard Frank, MD, PhD
- Padma Gulur, MD
- Daniel Halevy, MD
- Steven Hao, MD
- Michael Idowu, MD
- Kathy Jones, MD
- David Kanter, MD
- Janet McCauley, MD
- Daniel Nagle, MD
- Rahul Seth, DO
- Lawrence Simon, MD
- Timothy Swan, MD
The role of the CPT Advisory Committee
Supporting the Panel in its work is a larger body of CPT advisors, the CPT Advisory Committee. The members of this committee are primarily physicians nominated by the national medical specialty societies represented in the AMA House of Delegates. Currently, the advisory committee is limited to national medical specialty societies seated in the AMA House of Delegates and to the AMA Health Care Professionals Advisory Committee (HCPAC), organizations representing limited-license practitioners and other allied health professionals.
The advisory committee's primary objectives are to:
- Serve as a resource to the Panel by giving advice on procedure coding and appropriate nomenclature as relevant to the member's specialty.
- Provide documentation to staff and the Panel regarding the medical appropriateness of various medical and surgical procedures under consideration for inclusion in the CPT code set.
- Suggest revisions to the CPT code set. The advisory committee meets annually at the CPT February meeting to discuss items of mutual concern and to keep abreast of current issues in coding and nomenclature.
- Assist in the review and further development of relevant coding issues and in the preparation of technical education material and articles pertaining to the CPT code set.
- Promote and educate its membership on the use and benefits of the CPT code set.
Over the course of more than five decades, no taxpayer money has been spent to develop or maintain the CPT code set. The CPT code set is completed annually without cost to the U.S. government, and countless hours are spent to ensure that the CPT codes accurately reflect the medical care provided to patients.
Development of the CPT code
The AMA first developed and published CPT in 1966. The 1st edition helped encourage the use of standard terms and descriptors to document procedures in the medical record, helped communicate accurate information on procedures and services to agencies concerned with insurance claims, provided the basis for a computer oriented system to evaluate operative procedures and contributed basic information for actuarial and statistical purposes.
The first edition of CPT contained primarily surgical procedures, with limited sections on medicine, radiology and laboratory procedures. The 2nd edition was published in 1970 and presented an expanded system of terms and codes to designate diagnostic and therapeutic procedures in surgery, medicine and the specialties. At that time, a 5-digit coding system was introduced, replacing the former 4-digit classification. Another significant change was a listing of procedures relating to internal medicine.
In the mid to late 1970s, the 3rd and 4th editions of CPT were introduced. The 4th edition, published in 1977, represented significant updates in medical technology, and a system of periodic updating was introduced to keep pace with the rapidly changing medical environment. In 1983 CPT was adopted as part of the Centers for Medicare & Medicaid Services (CMS), formerly Health Care Financing Administration's (HCFA), Healthcare Common Procedure Coding System (HCPCS). With this adoption, CMS mandated the use of HCPCS to report services for Part B of the Medicare Program. In October 1986, CMS also required state Medicaid agencies to use HCPCS in the Medicaid Management Information System. In 2000, the CPT code set was designated by the Department of Health and Human Services as the national coding standard for physician and other health care professional services and procedures under the Health Insurance Portability and Accountability Act (HIPAA).
Today, in addition to use in federal programs (Medicare and Medicaid), CPT is used extensively throughout the United States as the preferred system of coding and describing health care services.
HIPAA and CPT
The Administrative Simplification Section of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires the Department of Health and Human Services to name national standards for electronic transaction of health care information. This includes transactions and code sets, national provider identifier, national employer identifier, security and privacy. The Final Rule for transactions and code sets was issued on Aug. 17, 2000. The rule names CPT (including codes and modifiers) and HCPCS as the procedure code set for:
- Physician services
- Physical and occupational therapy services
- Radiological procedures
- Clinical laboratory tests
- Other medical diagnostic procedures
- Hearing and vision services
- Transportation services including ambulance
The Final Rule also named ICD-10 volumes 1 and 2 as the code set for diagnosis codes, ICD-10-CM volume 3 for inpatient hospital services, CDT for dental services and NDC codes for drugs.
All health care plans and providers who transmit information electronically were required to use established national standards by the end of the implementation period, Oct. 16, 2003. In addition, all local codes were eliminated and national standard code sets were required for use after Oct. 16, 2003.
CPT® is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.
