Introduction to CPT and HCPCS Coding

CPT® Maintenance

Maintained and copyrighted by the American Medical Association (AMA).

Category I CPT® Codes

Five-digit numerical codes divided into six main sections, mandatory to report.

Six Main Sections of Category I CPT

Evaluation/Management, Anesthesiology, Surgery, Radiology, Pathology/Laboratory, and Medicine.

Category II CPT® Codes

Optional alphanumeric performance measurement tracking codes ending with the letter 'F'.

Category III CPT® Codes

Temporary alphanumeric codes for emerging technologies ending with the letter 'T'.

Semicolon (;) in CPT® Descriptions

Divides a code into a stand-alone common portion and an indented dependent descriptor.

Add-on Code Symbol (+)

Indicates codes never reported alone and listed separately in addition to the primary procedure.

HCPCS Level II

Maintained by CMS to identify products, supplies, and services not included in CPT®.

CMS Major Surgery Global Period

Includes a 1-day preoperative period and a 90-day postoperative period.

CMS Minor Surgery Global Period

Includes the day of the procedure plus a 0 or 10-day postoperative period.

Modifier 24

Unrelated E/M service by the same physician during a postoperative period.

Modifier 25

Significant, separately identifiable E/M service by the same physician on the procedure day.

Modifier 57

Decision for major surgery made on the day before or day of the procedure.

Modifier 50

Indicates a bilateral procedure performed during the same session.

Modifier 51

Indicates multiple procedures performed at the same session by the same provider.

Modifier 59

Indicates a distinct procedural service on a different session, site, or system.

Modifier 26 vs. TC

Modifier 26 covers the professional component; modifier TC covers the technical component.

Modifier 80

Indicates an assistant surgeon present for a substantial portion of an operation.

HCPCS Table of Drugs

Alphabetized resource providing drug names, doses, routes of administration, and codes.

Modifier JW

Reports drug amounts discarded and not administered from single-dose vials.