Importance of CPT® Category II Coding
Date: 06/19/24
What are CPT II codes?
CPT II codes are reporting codes that relay important information to Arkansas Total Care. This information can close quality care gaps related to specific health outcome measures.
Why are CPT II codes important?
CPT II codes should be submitted in conjunction with CPT or other codes used for billing and will decrease the need for record abstraction and chart reviews, thus minimizing your administrative burden.
How do you bill CPT II codes?
CPT II codes are billed in the procedure code field, just as CPT I codes are billed. CPT II codes describe clinical components usually included in evaluation and management or clinical services and are not associated with any relative value. Therefore, CPT II codes are billed with a $0.00 or $0.01 billable charge amount.
How can CPT II codes be used to close quality gaps in care on specific HEDIS® measures?
CPT II codes can relay important information related to health outcome measures, such as:
- Antipsychotic metabolic monitoring
- Controlling blood pressure
- Comprehensive diabetes care
- Care of older adults
- Medication reconciliation
- Prenatal and postpartum care
The following table lists the HEDIS quality measure, indicator description, and CPT II codes recognized in the HEDIS specifications for the current 2024 Provider Quality Reports.
- Antipsychotic Metabolic Monitoring
- Cholesterol (LDL-C) Testing: 3048F, 3049F, 3050F
- Controlling High Blood Pressure
- Blood Pressure Readings: 3074F, 3075F, 3077F, 3078F, 3079F, 3080F
- Comprehensive Diabetes Care
- A1C Results: 3044F, 3046F, 3051F, 3052F
- Eye Exam: 2022F, 2023F, 2024F, 2025F, 2026F, 2033F
- Care of Older Adults
- Advanced Care Planning: 1123F, 1124F, 1157F, 1158F
- Functional Status Assessment: 1170F
- Medication Review: 1111F, 1159F, 1160F
- Pain Screening: 1125F, 1126F
- Medication Reconciliation After Discharge
- Medication Reconciliation: 1111F
- Prenatal and Postpartum Care
- Prenatal Visit: 0500F, 0501F, 0502F
- Postpartum Visit: 0503F
CPT II Code Description Guide
0500F Initial prenatal care visit. Report at first prenatal encounter with healthcare professional providing obstetrical care. Also report date of visit and, in a separate field, the date of the last menstrual period.
0501F Prenatal flow sheet documented in medical record by first prenatal visit. Documentation includes at minimum blood pressure, weight, urine protein, uterine size, fetal heart tones, and estimated date of delivery. Report date of visit and, in a separate field, the date of the last menstrual period. Note: If reporting 0501F prenatal flow sheet, it is not necessary to report 0500F initial prenatal care visit.
0502F Subsequent prenatal care visit. Excludes: Patients who are seen for a condition unrelated to pregnancy or prenatal care, such as an upper respiratory infection; and patients seen for consultation only, not for continuing care.
0503F Postpartum care visit.
1111F Discharge medications reconciled with the current medication list in outpatient medical record.
1123F Advance care planning. Discussed and documented advance care plan or surrogate decision maker documented in the medical record.
1124F Advance care planning. Discussed and documented in the medical record. Patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.
1125F Pain severity quantified; pain present.
1126F Pain severity quantified; no pain present.
1157F Advance care plan or similar legal document present in the medical record.
1158F Advance care planning discussion documented in the medical record.
1159F Medication list documented in medical record.
1160F Review of all medications by a prescribing practitioner or clinical pharmacist documented in the medical record. Includes: Prescriptions, OTCs, herbal therapies, and supplements.
1170F Functional status assessed.
2022F Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy.
2023F Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy.
2024F Seven standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy.
2025F Seven standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy.
2026F Eye imaging validated to match diagnosis from seven standard field stereoscopic retinal photos results documented and reviewed; with evidence of retinopathy.
2033F Eye imaging validated to match diagnosis from seven standard field stereoscopic retinal photos results documented and reviewed; without evidence of retinopathy.
3044F Most recent hemoglobin A1c (HbA1c) level less than 7.0%.
3046F Most recent hemoglobin A1c level greater than 9.0%.
3048F Most recent LDL-C less than 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.
3051F Most recent hemoglobin A1c (HbA1c) level greater than or equal to 7.0% and less than 8.0%.
3052F Most recent hemoglobin A1c (HbA1c) level greater than or equal to 8.0% and less than or equal to 9.0%.
3074F Most recent systolic blood pressure less than 130 mm Hg.
3075F Most recent systolic blood pressure 130-139 mm Hg.
3077F Most recent systolic blood pressure greater than or equal to 140 mm Hg.
3078F Most recent diastolic blood pressure less than 80 mm Hg.
3079F Most recent diastolic blood pressure 80-89 mm Hg.
3080F Most recent diastolic blood pressure greater than or equal to 90 mm Hg.