EDITORIAL
Current Procedural Terminology/International
Classification of Diseases Coding in Plastic and
Reconstructive Surgery for Hard-to-Code or
Unusual Procedures
Raymond V. Janevicius, M.D.
Rod J. Rohrich, M.D.
April Handley
Elmhurst, Ill.; and Dallas, Texas
B
eginning with the May 2008 issue, Plastic and
Reconstructive Surgery will offer Current Pro-
cedural Terminology (CPT) and Interna-
tional Classification of Diseases (ICD-9) coding for a
selected article each month. Articles that describe
complicated or unusual reconstructive procedures,
or newer or more involved surgical procedures,
will be featured. This month, the article with such
coding is entitled “Anatomical Study of the Ulnar
Dorsal Artery and Design of a New Retrograde
Ulnar Dorsal Flap” by Vergara-Amador. The cod-
ing perspective is shown as an addendum to the
article, with coding on the particular procedures
described, along with a few explanations. The cod-
ing perspective is intended to provide unobtrusive
coding guidance and is secondary to the particular
clinical content of the article featured. The Journal
also offers procedural coding tables for its con-
tinuing medical education and Maintenance of
Certification–Plastic Surgery articles.
A BRIEF HISTORY OF CURRENT
PROCEDURAL TERMINOLOGY AND
INTERNATIONAL CLASSIFICATION OF
DISEASES CODING
Current Procedural Terminology is a list of
terms and codes that provides standardized ter-
minology for reporting medical procedures and
services.1,2 In addition to reporting services, it pro-
vides a uniform language for describing medical,
surgical, and diagnostic services among physi-
cians, coders, patients, insurance companies, and
accreditation providers.3 The codes are also used
Received for publication January 16, 2008; accepted Janu-
ary 16, 2008.
Copyright ©2008 by the American Society of Plastic Surgeons
DOI: 10.1097/PRS.0b013e31816b1a99
1850 www.PRSJournal.com
in developing medical care review guidelines and
in medical education and research.2
In 1966, the American Medical Association
developed and published the first Current Pro-
cedural Terminology. This first volume con-
tained primarily surgical procedures codes, us-
ing a four-digit system. Initially intended to help
standardize terminology among physicians and
provide a shorthand to simplify medical records
for physicians and medical records clerks, the
coding system had nothing to do with reim-
bursement. The second edition, published in
1970, replaced the four-digit codes with five-
digit codes. It also included codes for diagnostic
(laboratory) and therapeutic procedures in sur-
gery, medicine, and various specialties. The sys-
tem gained acceptance and became universal in
1983, when the Health Care Financing Admin-
istration (now called the Centers for Medicare
and Medicaid Services) merged Current Proce-
dural Terminology with its own Common Pro-
cedure Coding Systems, and mandated that Cur-
rent Procedural Terminology be utilized for all
Medicare billing. Medicaid followed suit and
adopted the system for its billing purposes in
1986. The current edition is CPT-2008.
The Current Procedural Terminology sys-
tem, developed and maintained by the Ameri-
can Medical Association, is governed by a 16-
member editorial panel. This group, composed
primarily of physicians, is empowered to make
final decisions regarding the content of Current
Procedural Terminology, deleting and adding
Disclosure: None of the authors has a financial
interest in any of the products, drugs, or devices
mentioned in this article.
Volume 121, Number 5 • Editorial
codes as they deem necessary. A total of 608 code
changes appear in CPT-2008 (244 codes have
been added, 50 have been deleted, and 314 have
been revised). The total number of codes in
CPT-2008 is 8805. The editorial panel is assisted
by the advisory committee, whose members rep-
resent nearly all of the medical specialty societ-
ies seated in the American Medical Association’s
House of Delegates. Additional advisory input
comes from the Current Procedural Terminol-
ogy/Health Care Professionals Advisory Commit-
tee, the Centers for Medicare and Medicaid Ser-
vices, the Blue Cross/Blue Shield Association, the
American Hospital Association, and the private
insurance industry. The editorial panel meets
quarterly to consider editing the codes. The Amer-
ican Medical Association’s Publications Office
produces standard, yearly additions to the codes,
as well as specific editions directed at the various
specialties.
Generating a new code or altering or delet-
ing an existing one constitutes a challenging
process that typically begins with a query to the
American Medical Association’s Current Proce-
dural Terminology Coding Office. Requests for
changes stem from a variety of sources, includ-
ing physicians, medical societies, manufactur-
ers, billing services, hospital coders, or other
interested parties. To request a new code or a
change to an existing one, the requesting party
fills out forms and must provide substantial doc-
umentation to support the request. Once the
request is duly made, the American Medical As-
sociation’s staff circulates the complete request
to the Current Procedural Terminology advisory
committee for opinions. If at least one member
of the committee responds favorably to the re-
quest, the request and opinions of the advisors
are placed on the agenda for the next meeting.
At that meeting, a presenter is available to an-
swer questions that the panel may have regard-
ing the request. Panel members vote to adopt,
reject, or alter the proposal.2
Current Procedural Terminology has three
types of codes. Category 1 codes describe a pro-
cedure or service identified with a five-digit code
and descriptor. Category 2 codes are optional
performance measurement tracking codes that
facilitate data collection of services and test re-
sults. Category 3 codes are for emerging tech-
nology, designating new technology, and pro-
cedures that are not yet in widespread use, as
well as for procedures awaiting U.S. Food and
Drug Administration approval.1
The International Statistical Classification of Dis-
eases and Related Health Problems (most often called
the International Classification of Diseases) provides
codes to classify diseases and a wide variety of signs,
symptoms, unusual findings, and causes of disease
or injury. Published by the World Health Organi-
zation, it is used globally to record morbidity and
mortality statistics, reimbursement systems, and
automated decision support in medicine. Cur-
rently in its tenth edition, it is scheduled to be
updated in 2011. It is interesting to note that while
ICD-10 was adopted in 1999 for reporting mor-
tality statistics, the ICD-9 remains the data stan-
dard for reporting morbidity.
The Current Procedural Terminology coding
system is the most widely used reimbursement sys-
tem in the United States. However, other coding
systems exist, including the following:
● Systematized Nomenclature of Medicine,
owned and operated by the College of Amer-
ican Pathologists;
● ICD-9 and ICD-10, published by the World
Health Organization; and
● Healthcare Common Procedure Coding Sys-
tem, maintained by the Centers for Medicare
and Medicaid Services.
Whereas Current Procedural Terminology
codes tend to be organized around procedures,
the International Classification of Diseases focuses
more on diagnoses.1
CURRENT PROCEDURAL
TERMINOLOGY, INTERNATIONAL
CLASSIFICATION OF DISEASES-9, AND
THE PLASTIC SURGEON
Given the current reimbursement, billing, and
insurance milieu in modern medicine, having an
extensive knowledge of and ability with Current
Procedural Terminology and International Classi-
fication of Diseases codes is of utmost importance to
the plastic surgeon. Without proper coding, rev-
enues for a surgeon’s practice will be severely and
negatively affected. Accurate and complete cod-
ing will help maximize reimbursement. Coding is
so important that many practices have a dedicated
coder who works in the billing department; cod-
ing courses for office managers and surgeons
alike are held throughout the country multiple
times each year. In addition, proper Interna-
tional Classification of Diseases reporting helps
document and track accurate statistics on mor-
bidity and mortality.
1851

The American Society of Plastic Surgeons is
dedicated to assisting its members with under-
standing and utilizing Current Procedural Termi-
nology and International Classification of Diseases
codes. Frequent coding updates are printed and
circulated to society members, the society spon-
sors coding workshops throughout the year, and
coding issues are discussed in every issue of Plastic
Surgery News, the society’s monthly newsletter. Dr.
Janevicius writes a coding column, “The CPT Cor-
ner,” that addresses specific coding issues. In con-
trast to the articles in Plastic Surgery News, the cod-
ing perspective in the Journal will focus on the
coding of the particular procedures described in
selected articles. The coding component will al-
ways be secondary to the clinical content of the
article and will serve as ancillary information only.
Future Meetings of the American Society of Plastic Surgeons
The following are the planned sites and dates for future annual meetings of the American Society of Plastic
Surgeons:
2008 Chicago, Ill.
2009 Seattle, Wash.
2010 Toronto, Canada
2011 Denver, Colo.
2012 Washington, D.C.
1852
Plastic and Reconstructive Surgery • May 2008
We hope that this initiative will be of interest and
help to the readership.
Raymond V. Janevicius, M.D.
360 W. Butterfield Road, Suite 230
Elmhurst, Ill. 60126
janevicius@sbcglobal.net
REFERENCES
1. Taubman, S. B. The Evolution of CPT—Current Procedural
Terminology. Medical Laboratory Observer, October 2000. Avail-
able at http://findarticles.com/p/articles/mi_m3230/is_10_
32/ai_66498630. Accessed January 10, 2008.
2. CPT code references. Medical Coding.net Available at http://
www.cpt-code.net/. Accessed January 10, 2008.
3. Black, S. AHS’s Headache coding corner: A user-friendly guide
to CPT and ICD coding. American Headache Society. Available
at http://www.americanheadachesociety.org/assets/headache_
coding_corner_part_1_final.pdf. Accessed January 10, 2008.
October 31 to November 4
October 23 to 28
October 1 to 6
September 23 to 28
November 1 to 7