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Category III CPT Codes (GEN)
Posted August 3, 2007
Generally, Category III CPT codes are not covered. As described in the CPT Manual, they are mainly for data collection. They have not met the requirements of Category I codes. If a Category III code describes a procedure, it should be used in place of an unlisted code, since it can identify what procedure was carried out and data can be collected in relation to that procedure. When it is necessary to use an unlisted code, use the unlisted codes from the family of related codes. When unlisted codes are used, the documentation should clearly delineate how the unlisted procedure is separately identified and described from an associated procedure or procedures.
The statement of the nature of added work or the additional duration of the procedure is helpful to the reviewer. If it is a separate procedure, clear documentation will allow the reviewer to compare it to other procedures for pricing. Covered Category III codes have been established in policy and coverage is described in an article, to advise regarding claims filing. |
