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.
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.
CPT is a listing of five-digit codes that identify services and procedures performed by physicians in any setting and by facilities for services and procedures performed in any outpatient setting. 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.
These digits are not intended to reflect the placement of the code in the regular (Category I) part of the CPT codebook.
Appendix H in CPT section contains information about performance measurement exclusion of modifiers, measures, and the measures' source(s). They are: CPT II codes are billed in the procedure code field, just as CPT Category I codes are billed. Court of Appeals for the Ninth Circuit held that the AMA could not enjoin a competitor on the basis that the AMA had misused its copyright.
It is also important to know when codes from another system, such as HCPCS Level II, are required. Medicine Examples of Category I codes include: 99253 Initial inpatient consultation 11770 Excision of pilonidal cyst or sinus; simple 33512 Coronary artery bypass, vein only, four coronary venous grafts 62270 Spinal puncture, lumbar, diagnostic 76498 Unlisted diagnostic radiographic procedures 78205 Liver imaging (SPECT) 86900 Blood typing, ABO 93010 Electrocardiogram, routine ECG with at least 12 leads; tracing only without interpretation or report Category II Codes Category II codes are supplemental tracking codes that are intended to be used for performance measurement. 0009F Anginal symptoms and level of activity, assessed 10.
Category I Codes Category I codes are the five-digit numeric codes included in the main body of CPT. In compliance with ongoing changes being made because of HIPAA regulations, these codes provide a method for reporting performance measures. 0004F Tobacco use cessation intervention, counseling 5. 0010F Anginal symptoms and level of activity, assessed using a standardized instrument. 0011F Oral anti-platelet therapy, prescribed (e.g., aspirin, clopidogrel/Plavix, or a combination of aspirin and dipyridamole/Aggrenox) The use of the Category II codes is expected to decrease the time spent abstracting a record.
The CPT code set (copyright protected by the AMA) describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes. CPT coding is similar to ICD-9 and ICD-10 coding, except that it identifies the services rendered, rather than the diagnosis on the claim (ICD-10-CM was created for diagnostic coding- it took the place of Volume 3 of the ICD-9).