CPT Category Ii Codes

CPT CATEGORY II CODES
What are they? CPT Category II Codes are reporting codes that relay important information to the health plan. This information can close quality care gaps
related to specific health outcome measures.
Why are they Important? CPT Category 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, minimizing your administrative burden.
How to bill CPT Category II Codes: CPT Category II codes are billed in the procedure code field, just as CPT category I codes are billed. CPT Category
II codes describe clinical components usually included in evaluation and management or clinical services and are not associated with any relative value.
Therefore, CPT Category II codes are billed with a $0.00 or $0.01 billable charge amount.
How can CPT Category II codes be used to close quality gaps in care on specific HEDIS measures?
CPT Category II codes can relay important information related to health outcome measures such as:
ACE/ARB Therapy Comprehensive diabetes care Medication Reconciliation
Controlling blood pressure Care of Older Adults Prenatal and Postpartum Care
The following table lists the HEDIS quality measure, indicator description, and the CPT Category II codes recognized in the HEDIS specifications for the
current 2020 Provider Quality Reports.
Quality Measure Indicator Description CPT Category II codes
Angiotensin Converting Enzyme (ACE) Inhibitor ACE/ARB Therapy 4010F
or Angiotensin Receptor Blocker (ARB) therapy
Controlling High Blood Pressure Blood Pressure Readings 3074F, 3075F, 3077F, 3078F, 3079F, 3080F
Comprehensive Diabetes Care A1C Results 3044F, 3045F, 3046F,
Eye Exam 2022F, 2024F, 2026F, 3072F
Nephropathy Screening 3060F, 3061F, 3062F, 3066F, 4010F
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
1-866-282-6280 (TDD/TTY: 711) ARTC20-H-040

©2020 Arkansas Total Care, Inc. All rights reserved. ArkansasTotalCare.com
CPT CATEGORY II CODES
CPT Category II Code Description Guide
0500F Initial prenatal care visit (report at first prenatal encounter with health care 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). Also report date of visit and, in a separate field, the date of the last menstrual period
[LMP]. (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 (eg, an upper respiratory
infection; 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 (such as, prescriptions, OTCs, herbal therapies and supplements)
documented in the medical record.
1170F Functional status assessed.
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 7 standard field stereoscopic photos results documented and reviewed.
3044F Most recent hemoglobin A1C (HbA1c) level less than 7.0%.
3045F Most recent hemoglobin A1C (HbA1c) level 7.0-9.0%.
3046F Most recent hemoglobin A1C level greater than 9.0%.
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 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.
4010F Angiotensin Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) therapy prescribed or currently being taken.
1-866-282-6280 (TDD/TTY: 711) ARTC20-H-040

©2020 Arkansas Total Care, Inc. All rights reserved. ArkansasTotalCare.com

CPT Category Ii Codes

Uploaded by

Copyright:

Available Formats

CPT Category Ii Codes

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

CPT Category Ii Codes

Uploaded by

Copyright:

Available Formats

CPT CATEGORY II CODES

1-866-282-6280 (TDD/TTY: 711) ARTC20-H-040

1-866-282-6280 (TDD/TTY: 711) ARTC20-H-040

You might also like