Technical codes exist in every industry; books use ISBN numbers, your Amazon orders all have shipping numbers, and perhaps most famously, libraries sort their books by the Dewey Decimal Classification or the Library of Congress Classification. Since 1966, hospitals have utilized their own system to identify procedures, services, and technologies in every hospital in the United States and many international hospitals.

The hospital industry titled that indexing system Current Procedural Terminology, or acronymically, CPT. Everything a hospital does has a CPT code. There are a few key things you need to know about CPTs:

• How they work

• How they’re categorized

• How to recognize common patterns in them

How They Work

As mentioned, everything a hospital does has a CPT code. Since 1966, this list of codes has grown and evolved, thanks to a process in the AMA where an application process filters codes and accepts or rejects requests. These five-digit codes are practical as well as technical; for example, a complex procedure uses its code to communicate nuanced ideas efficiently.

Hospitals use a computer indexing system to record every action with a CPT code. This means everything the hospital did for you at any of your visits has been computer-recorded. Because the hospital has recorded every move, you might be surprised when you don’t see the CPT codes on either of your bills (hospitals bill twice, once for administrative costs, and once for specialist costs). Thankfully, by request, hospitals are legally required to provide you with an “itemized bill” which gives line-by-line breakdowns of each charge, including the associated CPT codes.

Using this itemized bill, you can much more easily analyze the bill to see if they double-charged or made a mistake, which happens uncomfortably often - and far more often than the hospitals prefer to admit. Fortunately, Fairdoc advocates your case to the hospital, so if any mistakes happen, we will ensure the hospital provides a remedy to the bill as well as the patient. We’re here to inform and assist you.

How They’re Categorized

CPTs are categorized into three main categories, plus a new one the AMA recently introduced, all of which the AMA named uncreatively: Category 1, Category 2, Category 3, and Proprietary Laboratory Analyses (PLA), the newest categorical addition to CPT codes. Most important and most common is the first category, as well as the most likely to appear on your bill.

Category 1 codes correspond to a service or procedure. These codes always range from CPT 00100 to CPT 99607, and this body of codes exceeds all the other categories in size. These include common codes like CPT 36415 (venipuncture); CPT 83690 (lipase); and CPT 80048 & CPPT 80052 (metabolic panels).

Category 2 codes are alphanumeric, meaning they include both letters and numbers; each one has four numbers followed by the letter F. These codes are not linked to reimbursement, but knowing them is still useful. Hospitals assign these to supplemental tracking and performance measurement to track particular data about the patient, such as smoking habits.

Category 3 codes, which arrange themselves in similar format to Category 2, except ending in T, temporarily represent new and developing technology, procedures, and services. These codes can remain in Category 3 for up to five years before their temporary status disappears and the AMA either deletes or reassigns them.

How to Recognize Common Patterns in Them

The first two categories of CPTs organize themselves into subcategories, some of which are divided (like the anesthesia subcategory, which appears at both the beginning and end Category 1). Still, learning these subcategories will be helpful in recognizing overarching patterns and analyzing your hospital bill.

Category 1 has the codes you’re most likely to discover on your bill, including your medicine and procedures. Because it is both the most common and the most influential, this makes it the most important category. Category 1 contains six main subcategories, spanning from CPT 00100 to CPT 99607:

• Evaluation and Management (98000-98016, 99202–99499)

• Anesthesia (00100–01999, 99100-99140)

• Surgery (10004–69990)

• Radiology (70010–79999)

• Pathology and Laboratory (80047–89398)

• Medicine (90281–99199, 99500-99607)

Category 2 likely won’t appear on your bill, but here are the subcategories:

• Composite Codes (0001F–0015F)

• Patient Management (0500F–0584F)

• Patient History (1000F–1505F)

• Physical Examination (2000F–2060F)

• Diagnostic/Screening Processes or Results (3006F–3776F)

• Therapeutic, Preventive, or Other Interventions (4000F–4563F)

• Follow-up or Other Outcomes (5005F–5250F)

• Patient Safety (6005F–6150F)

• Structural Measures (7010F–7025F)

• Nonmeasure Code Listing (9001F–9007F)

Conclusion

There you have it! Everything you need to know about CPT codes, stored in one place. In summary, they are the tool hospitals use to index and itemize everything they do. You can access them if you request an “itemized bill.” The CPT codes on this bill will almost always come from Category 1, which includes the medicine you receive, the surgeries you undergo, and more. Category 2 includes more personal information which the hospital uses to customize care to the patient.

And maybe, next time you visit the library, ask your librarian how well they know their Dewey Decimal System.