How an Idea Becomes a Code: Demystifying the CPT Process

CPT codes standardize medical procedural work and values; they are a gateway for 3rd party reimbursement. The process of the codes’ creation and proper use is often ignored and poorly understood in medical training. This manuscript intends to familiarize the readers with the process of code creation, its criteria, and the valuation process. Particular attention is paid to the valuation process, and the importance of practitioner involvement in this realm is stressed. Finally, unintended and undesired consequences of code misuse are highlighted.

Misreporting of novel medical procedures in Otolaryngology has threatened existing procedures’ valuation and subsequent reimbursement.

This review intends to improved comprehension of the CPT code creation and valuation process to avoid the unintended consequences of misreporting.