Readers are forever complaining to us that they spend too much time looking up codes and figuring out which ones to use. One of the more printable complaints came from an internist in Sunnyvale, CA, who told us she'd like "whoever's running things to scrap the system!" "CPT is everyone's favorite punching bag," agrees Christopher G. Chute, professor of medical informatics at the Mayo Clinic College of Medicine in Rochester, MN.

But the keepers of the coding system didn't really design CPT just to make you crazy. Before CPT codes existed and when ICD-9-CM codes were in their infancy, doctors had to write out in words what symptoms a patient had, what the diagnosis probably was, and what visits, services, and procedures they thought they should get paid for.

"Doctors eyeballed appointments at the end of a day," recalls Philip N. Eskew Jr., an ob/gyn at St. Vincent Indianapolis (IN) Hospital and vice chair of the AMA's CPT Editorial Panel from 1985 to 1995. "They tended to write out their charts and bills in shorthand, documenting, for example, 'PE WNL' for 'physical examination within normal limits.' Not much documentation was required.

"The insurance companies and the government accepted this for a while, but by the early 1960s they decided, and rightly so, that they didn't want to pay for services that were only vaguely described. Plus, the system was subject to abuse." In those pre-managed care days, time wasn't an issue, so office visits could be "extended" when, in reality, the time might be spent talking about baseball. Of course, most doctors acted appropriately, but because no one was looking, no one was accountable.

A quick guide to understanding CPT The Health Care Financing Administration (now Centers for Medicare & Medicaid Services) challenged physicians to do a better job. In the early 1980s, the AMA set up the CPT Editorial Panel and surveyed doctors to break down every step in an office visit. They asked: What do you do to get ready to see a patient? What do you ask a patient? How do you examine a patient? What do you document on the chart? What do you do when a patient leaves the office? With this information, the committee created the system we know today.

"Our thinking was that documentation should be thorough enough so that if another physician picked up the chart, he'd know not only what systems had been reviewed, but what the thought process was and what should be done with the patient," says Eskew.

Current Procedural Terminology codes were first published by the AMA in 1966 and are updated annually. The codes become effective on Jan. 1 each year, and new CPT books and electronic versions are available in the fall of each year preceding their effective date.

CPT has undergone four major revisions during the past nearly 40 years. The first edition was an attempt to standardize terms and descriptions in the medical record so that data could be used for actuarial and statistical purposes. Four-digit codes described primarily surgical procedures. In 1970, a second edition introduced five-digit codes with expanded terms designating therapies used in internal medicine and the specialties. Seven years later, a fourth edition launched a system of periodic updates to keep pace with the rapidly changing medical environment.

Category I codes describe procedures or services identified with a five-digit code. In recent years, the AMA has added Category II codes (performance measurements) and Category III codes (new and emerging technology) to its manual.