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Review
Current procedural terminology; a primer
  1. Joshua A Hirsch1,
  2. Thabele M Leslie-Mazwi2,
  3. Gregory N Nicola3,
  4. Robert M Barr4,
  5. Jacqueline A Bello5,
  6. William D Donovan6,
  7. Raymond Tu7,
  8. Mark D Alson8,
  9. Laxmaiah Manchikanti9,10
  1. 1Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts USA
  3. 3Hackensack University Medical Center, Hackensack, New Jersey, USA
  4. 4Mecklenburg Radiology Associates P.A., Charlotte, North Carolina USA
  5. 5Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
  6. 6Norwich Diagnostic Imaging Associates, Norwich, Connecticut, USA
  7. 7Department of Progressive Radiology, The George Washington University, Falls Church, Virginia, USA
  8. 8Sierra Imaging Associates, Clovis, California, USA
  9. 9Pain Management Center of Paducah, Paducah, Kentucky, USA
  10. 10Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky, USA
  1. Correspondence to Dr Joshua A Hirsch, Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Hirsch{at}snisonline.org

Abstract

In 1966, The American Medical Association (AMA) working with multiple major medical specialty societies developed an iterative coding system for describing medical procedures and services using uniform language, the Current Procedural Terminology (CPT) system. The current code set, CPT IV, forms the basis of reporting most of the services performed by healthcare providers, physicians and non-physicians as well as facilities allowing effective, reliable communication among physician and other providers, third parties and patients. This coding system and its maintenance has evolved significantly since its inception, and now goes well beyond its readily perceived role in reimbursement. Additional roles include administrative management, tracking new and investigational procedures, and evolving aspects of ‘pay for performance’. The system also allows for local, regional and national utilization comparisons for medical education and research. Neurointerventional specialists use CPT category I codes regularly—for example, 36 215 for first-order cerebrovascular angiography, 36 216 for second-order vessels, and 37 184 for acute stroke treatment by mechanical means. Additionally, physicians add relevant modifiers to the CPT codes, such as ‘−26’ to indicate ‘professional charge only,’ or ‘−59’ to indicate a distinct procedural service performed on the same day.

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