Medical Billing Forum

Coding => Coding => Topic started by: Boatman04 on June 08, 2010, 03:59:32 PM

Title: Test/Procedure CPT Codes
Post by: Boatman04 on June 08, 2010, 03:59:32 PM
What is the difference between a test CPT code and a Procedure CPT code?

I am confused!!!  The doctor I work for asked me this questions and I am really not sure. ???
Title: Re: Test/Procedure CPT Codes
Post by: oneround on June 08, 2010, 04:48:17 PM
I am going to assume that when referring to 'TEST' CPT codes you are referring to what is also known as a catagory III CPT code.  Catagory 1 codes are what is reconiaed by all facilities, carriers and coders.  Please see description below.

Category I: Procedures that are consistent with contemporary medical practice and are widely performed.

Category II: Supplementary tracking codes that can be used for performance measures.

Category III: Temporary codes for emerging technology, services and procedures.

Category I Codes

Category I codes are the five-digit numeric codes included in the main body of CPT. Category I is the section that coders usually identify with when talking about CPT. These codes represent procedures that are consistent with contemporary medical practice and are widely performed. Codes assigned to this category have met certain criteria including:

Procedure or service approved by the Food and Drug Administration (FDA)

Procedure or service commonly performed by health care professionals nationwide

Procedure or service's clinical efficacy is proven and documented

Category I codes are used by physicians and by most outpatient providers when reporting a significant portion of their services and procedures. Category I codes are updated annually and are broken down into six sections.

1. Evaluation and Management

2. Anesthesiology

3. Surgery

4. Radiology

5. Pathology and Laboratory

6. Medicine

Category II Codes

Category II codes are supplemental tracking codes that are intended to be used for performance measurement. In compliance with ongoing changes being made because of HIPAA regulations, these codes provide a method for reporting performance measures. The Category II codes are intended to facilitate the collection of information about the quality of care delivered by coding a number of services or test results that support performance measures. These performance measures have been agreed upon as contributing to good patient care.

The Category II Codes are alphanumeric and consist of four digits followed by the alpha character 'F.' The use of these codes is optional and are not a substitute for Category I codes.

CPT Category II codes will be arranged according to the following categories:

Composite Measures 0001F

Patient Management 0500F-0503F

Patient History 1000F-1002F

Physical Examination 2000F

Diagnostic/Screening Processes or Results 3000F

Therapeutic, Preventive or Other Interventions 4000F-4011F

Follow-up or Other Outcomes 5000F

Patient Safety 6000F

The use of the Category II codes is expected to decrease the time spent abstracting a record. They are also intended to decrease the time spent by physicians and other health professionals on chart review to verify that the measures were preformed. For example, if you are trying to track the use of statin therapy in your practice, reporting code 00067F, Statin therapy, prescribed, will allow you to do this through your coding or billing rather than through chart review.

These codes may typically describe services that are included in an evaluation and management (E/M) service. Therefore the Category II CPT codes will not have relative value units (RVUs). The services are embedded within the E/M code in which the aggregate service has already been valued. Category II codes are not recognized by the OCE in hospital outpatient billing of Medicare patients. They may be used for internal tracking and reporting, however it is important that these codes not be included on Medicare OPPS claims.

The tracking codes are reviewed by the Performance Measures Advisory Group (PMAG), an advisory body to the CPT Editorial Panel. The PMAG comprises performance measurement experts representing the Agency of Healthcare Research and Quality (AHRQ), the American Medical Association (AMA), the Centers for Medicare and Medicaid Services (CMS), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA) and the Physician Consortium for Performance Improvement.

The Category II codes are released annually

Category III Codes

Category III codes represent temporary codes for new and emerging technologies. They have been created to allow for data collection and utilization tracking for new procedures or services. Category III codes are different from Category I CPT codes in that they identify services that may not be performed by many health care professionals across the country, do not have FDA approval, nor does the service/procedure have proven clinical efficacy. To be eligible for a Category III code, the procedure or service must be involved in ongoing or planned research. The rationale behind these codes is to help researchers track emerging technology and services to substantiate widespread usage and clinical efficacy. In the past, researchers have been hindered by the length and requirements of the current CPT approval process.

The Category III codes are five characters long, with four digits followed by the letter 'T' in the last field (e.g. 0002T). The codes are intended to be temporary and will be retired if the procedure or service is not accepted as a Category I code within five years. In some instances Category III codes may replace temporary local codes (HCPCS Level III) assigned by carriers and intermediaries to describe new procedures or services. If a Category III code is available it must be used instead of the unlisted Category I code. The use of the unlisted code does not offer the opportunity for collection of specific data.

Early release of these codes is possible because payment for these services is based on the policies of payers and not on a yearly fee schedule. CMS began recognizing a number of the Category III codes as of Jan. 1, 2002, and has designated certain codes as covered.

Examples of Category III codes are as follows:

0005T Transcatheter placement of extracranial cerebrovascular artery stent(s), percutaneous; initial vessel

0007T Transcatheter placement of extracranial cerebrovascular artery stent(s), percutaneous, radiological supervision and interpretation, each vessel

0012T Arthroscopy knee, surgical, implantation of osteochondral graft(s) for treatment of articular surface defect, autografts

0058T Cryopreservation, reproductive tissue, ovarian

If there is a HCPCS Level II code that also describes the new technology or service identified by a Category III code, then the HCPCS Level II code must be assigned when reporting Medicare claims. For example, Category III code 0019T, Extracorporeal shock wave therapy; involving musculoskeletal system, should not be reported to Medicare. Medicare created two HCPCS Level II codes G0279 Extracorporeal shock wave therapy; involving elbow epicondylitis, and G0280, Extracorporeal shock wave therapy; involving other than elbow epicondylitis or plantar fascitis, that must be reported in place of Category III code 0019T.