The 5-digit numerical CPT codes for the specialty of pathology span from 80048 to 89356, with specimens in surgical pathology spanning from 88300 to 88309. 6 Category II codes are optional supplemental tracking codes used for performance measurement, and they enable data collection regarding quality of care. After 5 years, either these codes are determined to meet criteria to be converted to Category I or they are retired. 6 They allow for a procedure/service to be tracked in order to determine the extent of use nationally. Category III codes are a temporary set of codes that do not yet meet criteria to be approved as Category I codes. 5 Category I is divided into 6 sections: evaluation and management, anesthesiology, surgery, radiology, pathology and laboratory, and medicine. The majority of codes fall under Category I, and any new Category I codes must meet several specific criteria: (1) any necessary devices and/or drugs have approval or clearance from the US Food and Drug Administration, (2) the procedure/service is performed by many health care providers throughout the country, (3) the frequency at which the procedure/service is performed is consistent with its intended clinical use, (4) the procedure/service is consistent with current medical practice, and (5) there is sufficient literature documenting the clinical efficacy of the procedure/service.
#CPT MANUAL PROFESSIONAL EDITION 2016 CODE#
2, 4 In accordance with the AMA's open policy with regard to CPT code changes, the AMA website provides an application process for CPT code revisions, which may be submitted by a variety of parties, including individual physicians, medical specialty societies, and third-party payers. 4 The responsibilities of the advisors include submitting code change proposals, commenting on code change proposals submitted by others, providing literature regarding efficacy and appropriateness of new procedures and the work involved therein, promoting education of committee membership, and functioning as liaisons between the panel and the members' respective medical specialties. The advisory committee members are primarily physicians nominated by national medical specialty societies in the AMA House of Delegates. 2, 4 The panel meets 3 times annually to evaluate all code change proposals, and is assisted by a larger body of CPT advisors who make up the CPT Advisory Committee. The 17-member panel consists of rotating members with representation from physicians, nonphysician health care providers, payers, and the American Hospital Association.
Initially, the panel operated under a closed-door policy however, in 1992, a more open process was adopted. The evolution and expansion of CPT codes was paralleled by an evolution in the system for maintaining and updating existing codes, which is the responsibility of the CPT Editorial Panel.