Help Get CPT Code for the Mini-Gastric Bypass

Help Get CPT Code for the Mini-Gastric Bypass

Amplify’d from www.ama-assn.org

Criteria for development and evaluation of CPT® Category I and Category III Codes

In developing new and revised Category I codes the CPT Advisory Committee and the CPT Editorial Panel require:

  • that the service/procedure has received approval from the Food and Drug Administration (FDA) for the specific use of devices or drugs;
  • that the suggested procedure/service is a distinct service performed by many physicians/practitioners across the United States;
  • that the clinical efficacy of the service/procedure is well established and documented in U.S. peer review literature;
  • that the suggested service/procedure is neither a fragmentation of an existing procedure/service nor currently reportable by one or more existing codes; and
  • that the suggested service/procedure is not requested as a means to report extraordinary circumstances related to the performance of a procedure/service already having a specific CPT code.

The following is used as formalized criteria by the CPT Advisory Committee and the CPT Editorial Panel for evaluating Category III code requests and includes identification of the following elements as guidelines for establishment of a Category III code:

  • A protocol of the study or procedures being performed;
  • Support from the specialties who would use this procedure;
  • Availability of United States peer-reviewed literature for examination by the Editorial Panel;
  • Descriptions of current United States trials outlining the efficacy of the procedure.

Frequently Asked Questions (FAQs)

View the Frequently Asked Questions (FAQs) regarding the CPT Process.

CPT® Process Information and Documents

The documents found through the links below provide information about the creation of codes in CPT® as well as the instructions and forms to apply for new codes.

CPT® Background and Categories of CPT® Codes
Newly developed categories of CPT codes.

CPT® Coding Change Process Cover Memo
Cover memo to CPT coding change requestor.

Coding Change Request Form Instructions
AMA CPT – instructions for requesting a CPT coding change.

Category I and Category III Coding Change Request form
AMA CPT form to submit a CPT coding change request.

Category I “Short Form” Coding Change Request form
AMA CPT form to submit a CPT coding change request for Specialty Society use only.  This form is to be used when submitting the requests that are required by the Five Year Review.

CPT® Pathology & Laboratory Coding Change Request Form
AMA CPT Form to submit a CPT coding change request.

Category II Code Application
AMA CPT Category II code application and instructions for applying.

CPT® Sample Format for Required Clinical Vignette(s)
AMA CPT Sample clinical vignette for CPT process

Read more at www.ama-assn.org

 

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