August 2009
Category II codes increase data completeness and may reduce medical record reviews
According to the 2009 Current Procedural Terminology (CPT®) manual, all category II codes should be billed with no charge. Any charge (e.g., 1 cent) submitted for these codes causes a delay in the processing and payment of the claim. Please remember to list a charge of $0.00 for category II codes.
Category II CPT codes do not have a relative value associated with them. They are supplemental tracking codes used to measure performance. Use of these codes:
- Decreases the need for record abstraction and chart review
- Reduces the administrative burden on providers and other entities interested in measuring patient care quality
- Facilitates data collection related to quality of care rendered by coding certain services and test results that support nationally established and evidence-based performance measures
These codes describe clinical components typically included in evaluation and management services or clinical services. They 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.
Examples of codes that increase the completeness of administrative data collection include:
- CPT 3044F Most recent hemoglobin A1c (HbA1c) level less than 7.0% (DM)
- CPT 3048 Most recent LDL-C less than 100 mg/dL (DM)
The use of these codes is optional and is not required for correct coding. They may not be used as a substitute for category I codes.