Current Procedural Terminology Category II Codes (CPT-2 Codes) | June 2022 | Clinical Corner

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June 15, 2022

Current Procedural Terminology Category II Codes (CPT-2 Codes)

 

WHAT ARE CPT-2 CODES:

They describe the following:

  • Clinical components, such as those typically included in evaluation, management, or other clinical services.
  • Results from clinical laboratory or radiology tests and other procedures.
  • Identified processes intended to address patient safety practices (such as fall risk).
  • Services reflecting compliance with state or federal law.

 

PURPOSE:

CPT II codes help define nationally established performance measures by facilitating data collection regarding the quality of care rendered. Additionally, they are used:

  • To ease the administrative burden of chart review for many HEDIS™ performance measures.
  • To monitor internal performance for key measures throughout the year, rather than once per year as measured by health plans and Pay for Performance.
  • To identify opportunities for improvement so interventions can be implemented to improve performance during the service year.

 

DIABETES CARE EXAMPLE:

A1C Testing

• A1c < 7% - 3044F

• A1c greater than or equal to 7% but less than 8% - 3051F

• A1c greater than or equal to 8% but less than 9% - 3052F

• A1c > 9% - 3046F

 

BENEFITS OF CPT-2 CODES:

Although CPT II codes are billed with a $0.00 billable charge amount…

  • HEDIS metrics are captured more efficiently, and gaps are closed.
  • Metrics for our Gain Sharing Contracts are fulfilled easier and revenue from quality performance is increased.
  • Patient outcomes are improved, and expenditures are decreased.
  • It will assist you in identifying patients in your panel who may need increased clinical oversight or adjustment in their treatment plans to achieve their desired health status.

 

Codes are available in Cerner under “Quick Orders” and will be tracked to ensure that they are sent and received by the payers.

REFERENCE:

https://medicarepaymentandreimbursement.com/2019/06/cpt-category-ii-codes-why-and-what-is.html