What Are CPT II Codes?

CPT Codes

What are CPT® II codes?

Category II CPT® Codes are supplemental tracking codes used to measure performance. It is anticipated that the use of these codes will decrease the need for record abstraction and chart review and assist the provider in minimizing the administrative burden in measuring the quality of patient care. They are intended to facilitate data collection about the quality of care rendered by coding certain services and test results that support nationally established performance measures (HEDIS) and that have an evidence base as contributing to quality patient care.

How are CPT® II codes developed?

Category II codes are reviewed by the Performance Measures Advisory Group (PMAG), an advisory body to the CPT® Editorial Panel and the CPT®/HCPAC Advisory Committee. The PMAG is comprised of performance measurement experts representing the Agency for Healthcare Research and Quality (AHRQ), the American Medical Association (AMA), the Centers for Medicare and Medicaid Services (CMS), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA), and the Physician Consortium for Performance Improvement. The PMAG may seek additional expertise and/or input from other national health care organizations, as necessary, for the development of tracking codes. These may include national medical specialty societies, other national health care professional associations, accrediting bodies, and federal regulatory agencies.

Why should I use CPT® II codes?

These codes describe clinical components that may be typically included in evaluation and management services or clinical services and, therefore, do not have a relative value associated with them. Category II codes may also describe results from clinical laboratory or radiology tests and other procedures, identified processes intended to address patient safety practices, or services reflecting compliance with state or federal law.

The use of CPT® II codes can ease the administrative burden of chart retrieval and review for many of the HEDIS™ performance measures throughout the year. Use of these codes enables your office to monitor internal performance of key measures throughout the service year. By identifying opportunities for improvement, interventions can be implemented to improve performance.

Providers are not required to use these codes, as they are not required for the Correct Coding Initiatives and may not be used as a substitute for Category I codes.

Where can I find a list of CPT® II Codes?

CPT® II codes are released annually as part of the full CPT® code set and are updated semi-annually in January and July by the AMA. The current listing of CPT® II codes can be found on the AMA Website at http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/category-ii-codes.page.

How do I bill CPT® II codes?

CPT® Category II codes are arranged according to the following categories and are comprised of four digits followed by the letter “F”.

·  Composite Measures 0001F-0015F

·  Patient Management 0500F-0575F

·  Patient History 1000F-1200F

·  Physical Examination 2000F-2050F

·  Diagnostic/Screening Processes/Results 3006F-3573F

·  Therapeutic, Preventive or Other Interventions 4000F-4306F

·  Follow-up or Other Outcomes 5005F-5100F

·  Patient Safety 6005F-6045F

·  Structural Measures 7010F-7025F

CPT® II codes describe clinical components that may be typically included in evaluation and management services or clinical services and, therefore, do not have a relative value associated with them. Therefore, CPT® II codes are billed with a $0.00 billable charge amount.

How can my office use CPT® II codes to track our performance on specific HEDIS™ measures?

This is not a complete list of CPT® II category codes-refer to the AMA CPT Codes & Descriptions© for a full list. Refer to NCQA Volume 2 HEDIS[1] Technical Specifications 2014 for a complete list of codes in the administrative specifications for each measure.

STARs Measure / Measure Description / Indicator Description / CPT® Category II Codes /
C01 / Breast Cancer Screen / Mammography & results / 3014F
/
C02 / Colorectal Screen / 3017F /
C03 / Cardiovascular Care- Cholesterol Screening / LDL-C test & level / 3048F, 3049F, 3050F /
C04 / Diabetes Care-Cholesterol Screening / LDL-C test & level / 3048F, 3049F, 3050F /
C05 / Glaucoma Testing / Optic Nerve evaluation
/ 2027F /
C06 / Annual Flu Vaccine / Vaccine Administered/reported / 4274F /
C10 / Adult BMI / BMI assessed/documented / 3008F /
C14 / Osteoporosis Management / Female plan members who broke a bone and got screening or treatment for osteoporosis within 6 months / 3095F, 3096F, 4005F,
4019F /
C15 / Diabetes Care- Eye Exam / Retinal Eye Exam / 2022F, 2024F, 2026 F, 3072F /
C16 / Diabetes Care- Kidney Disease Monitoring / Urine Protein Screening / 3060F, 3061F, 3062F, 3066F, 4010F /
C17 / Diabetes Care-Blood Sugar Controlled / HgA1c test & HgA1c Level / 3044F, 3045F,3046F /
C18 / Diabetes Care-Cholesterol Controlled / LDL-C test & level / 3048F,3049F,3050F /
C19 / Controlling Blood Pressure / Blood Pressure readings / Systolic Codes:3074F, 3075F
3077F
Diastolic Codes: 3078F, 3079F, 3080F /
C20 / Rheumatoid Arthritis Management / Patients with Rheumatoid Arthritis who received 1 or more prescriptions for anti-rheumatics / 4187F /
Category II Code / Description /
2022F / Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed /
2024F / 7 standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed /
2026F / Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed /
2027F / Optic nerve head evaluation performed /
3008F / Body Mass Index (BMI), documented /
3014F / Screening mammography results documented and reviewed /
3017F / Colorectal cancer screening results documented and reviewed /
3044F / Most recent hemoglobin A1c (HbA1c) level < 7.0% /
3045F / Most recent hemoglobin A1c (HbA1c) level 7.0% to 9.0% /
3046F / Most recent hemoglobin A1c (HbA1c) level > 9.0% /
3048F / Most recent LDL-C < 100 mg/dL /
3049F / Most recent LDL-C 100 - 129 mg/dL /
3050F / Most recent LDL-C greater than or equal to 130 mg/dL /
3060F / Positive microalbuminuria test result documented and reviewed /
3061F / Negative microalbuminuria test result documented and reviewed /
3062F / Positive macroalbuminuria test result documented and reviewed /
3066F / Documentation of treatment for nephropathy (eg, patient receiving dialysis, patient being treated for ESRD, CRF, ARF, or renal insufficiency, any visit to a nephrologist) /
3072F / Low risk for retinopathy (no evidence of retinopathy in the prior year) /
3074F / Most recent systolic blood pressure < 130 mm Hg /
3075F / Most recent systolic blood pressure 130 to 139 mm Hg /
3077F / Most recent systolic blood pressure ≥ 140 mm Hg /
3078F / Most recent diastolic blood pressure < 80 mm Hg /
3079F / Most recent diastolic blood pressure 80 - 89 mm Hg /
3080F / Most recent diastolic blood pressure ≥ 90 mm Hg /
3095F / Dual-energy X-Ray Absorptiometry (DXA) results documented /
3096F / Central Dual-energy X-Ray Absorptiometry (DXA) ordered /
4005F / Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed /
4010F / Angiotensin converting enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) therapy prescribed or currently being taken /
4013F / Statin therapy prescribed or currently being taken /
4019F / Documentation of receipt of counseling on exercise AND either both calcium and vitamin D use or counseling regarding both calcium and vitamin D use /
4187F / Disease modifying anti-rheumatic drug therapy prescribed, dispensed, or administered /
4274F / Influenza immunization administered or previously received /

[1] HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)