1. Category II & Category III
The Complete Procedure Coding Book By Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA
Chapter 12
Category II & Category III
Coding
McGraw Hill/Irwin
Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved

2. Learning Outcomes
12-2
Interpret the guidelines for using category II codes.
Identify the guidelines for using category III codes.
Apply the guidelines to determine the best category II code.

3. Learning Outcomes
12-3
Utilize the guidelines to ascertain the best category III code.
Correct use category II code modifiers.
Correctly follow notational instructions with category III codes.

4. Introduction
12-4
Category II codes are used for statistical purposes, including the new Physician Quality Reporting Initiative.
Category III codes report the use of new, emerging technologies.

5. Category II Codes
12-5
Used in conjunction with Appendix H Alphabetic Index of Performance Measures by Clinical Condition or Topic
Report specific protocols accomplished during a patient encounter

6. Category II Codes Category II codes are not used for reimbursement
12-6
Category II codes are not used for reimbursement
CMS uses category II codes in determining physician bonus payments under the PQRI program.
They are reported on the CMS-1500 claim form with a charge of $0.00.

7. Category II Codes
12-7
Each category II code has 5 characters: 4 numbers followed by the letter F
Example: 3006F

8. Category II Codes Compiled in 8 categories Composite measures
12-8
Compiled in 8 categories
Composite measures
Patient management
Patient history
Patient examination
Diagnostic/screening processes
Therapeutic, preventive & interventions
Follow-up
Patient safety

9. Category II Codes
12-9
Appendix H provides additional detail to assist with the assigning of the correct Category II code.

10. Category II Modifiers 1P Due to medical reasons
12-10
Explain why a protocol was
not provided.
1P Due to medical reasons
2P Due to patient reasons
3P Due to system reasons

11. PQRI Participation Identify Medicare-covered patients who qualify.
12-11
Identify Medicare-covered patients who qualify.
Document fulfillment of measure in notes for the encounter.
Select appropriate Category II code.
Submit codes on CMS-1500.

12. Category III Codes
12-12
Emerging technology and procedures not yet accepted as standard of care
Some insurance carriers may consider these experimental procedures.

13. Category III Codes
12-13
Category III codes have 5 characters: 4 numbers followed by the letter T
Example: 0016T

14. Category III Codes A regular CPT code is not appropriate. AND
12-14
Use a Category III code when:
A regular CPT code is not appropriate.
AND
A Category III code is appropriate.

15. Category III Notations
12-15
When a procedure is accepted into regular clinical practice, the procedure gets a regular CPT code, and its Category III code is deleted.
Example: (0023T has been deleted. To report, use 87900)

16. Category III Notations
12-16
Category III codes may be reported with regular CPT codes.
Example: (Use 0068T in conjunction with 93000)

17. Category III Notations
12-17
Some Category III codes are not permitted to be reported with some CPT codes.
Example: (Do not report 0065T in conjunction with or 99173)

18. Category III Notations
12-18
Some Category III notations will direct you to a CPT code that may be more accurate.
Example: (For diagnostic epidurography, use 64999)

19. Chapter Summary
12-19
Use category II codes for statistical purposes. Use category III codes for the use of new, emerging technologies. Both category II and category III codes are updated twice a year: January 1st and June 1st.