CPT Category II and Z codes aid data collection, lessen administrative work for offices

What are CPT Category II and Z codes?
CPT Category II codes are tracking codes, while Z codes are diagnosis codes. Certain CPT II codes and Z codes facilitate data collection for HEDIS^® measures.** They can give you credit for quality care without the need for medical record review and can help you close gaps for HEDIS measures.

Here’s a closer look:

• CPT Category II codes describe components that are usually included in the evaluation and management process, such as A1c or blood pressure test results. They are billed in the procedure code field like CPT Category I codes are.
• Z codes are diagnosis codes. To illustrate how they might be used to facilitate data collection, submitting a claim with the appropriate ICD-10 diagnosis code to indicate a patient’s body mass index will alleviate the need to review the member’s medical record for BMI documentation.

Why should my practice use CPT Category II and Z codes?
The use of CPT Category II and Z codes on claims eases an office’s administrative burden. It does this by decreasing, while not completely eliminating, the need for medical record reviews to determine if certain HEDIS measures are met. Performance on certain HEDIS measures influences the level of reimbursement providers can receive through various incentive programs.

CPT Category II codes are adopted and reviewed by the Performance Measure Advisory Group, or PMAG. PMAG is made up of experts in performance measurement from organizations such as the American Medical Association, the National Committee for Quality Assurance, the Centers for Medicare & Medicaid Services and others.

For more information, download or print the following:

• CPT II quick guide for closing gaps for HEDIS measures
• HEDIS claim coding reference guide

**HEDIS^®, which stands for Healthcare Effectiveness Data and Information Set, is a registered trademark of the National Committee for Quality Assurance.