Clarification about Assigning a Surgical Category when Patient Record Lists Multiple, Survey-eligible CPT Codes
folder_openSurvey Specifications and Guidelinescalendar_todayPosted June 14, 2016

OAS CAHPS survey vendors may receive patient records from their client HOPDs and/or ASCs with multiple, survey-eligible CPT codes from different surgical categories. When this happens, vendors should use the first CPT code that is OAS CAHPS Survey-eligible to identify the surgical category, as this is typically the code for the primary surgery.

As a reminder, each sampled patient record must be classified into one of the 4 surgical categories: gastrointestinal, orthopedic, ophthalmologic, or other based on the CPT¹ or G code. The categories are as follows:

• Surgical category 1 (Gastrointestinal) 40000-49999 or G0105, G0121, or G0104
• Surgical category 2 (Orthopedic) 20000-29999 or G0260
• Surgical category 3 (Ophthalmologic) 65000-68899
• Surgical category 4 (Other) 10021-19999, 30000-39999, 50000-64999, and 68900-69990

Below are two examples of CPT codes, their corresponding surgical categories, and how to handle categorizing the record in the XML data file:

1. 40701 (Gastrointestinal), 69436 (Other) --> Record as Surgical Category #1.
2. 69631 (Other), 20926 (Orthopedic) --> Record as Surgical Category #4.

The OAS CAHPS Survey Coordination Team will include this additional guidance to the next edition of the OAS CAHPS Protocols and Guidelines Manual. Please contact the OAS CAHPS Survey Coordination Team via e-mail at oascahps@rti.org or call toll-free (866) 590-7468 if you have any questions.

¹CPT only copyright 2015 American Medical Association. All rights reserved.