Drugs in the Pathology/Laboratory Section of CPT are Listed by Their Generic Names
In the Pathology/Laboratory section of the CPT, drugs are listed by their generic names, not by brand, manufacturer's, or chemical names. 1
Understanding Drug Nomenclature in CPT Coding
The Current Procedural Terminology (CPT) manual maintains consistency in the Pathology/Laboratory section by using standardized generic drug names for all listed medications. This practice has several important implications for medical coding and billing:
Why Generic Names Are Used
- Standardization: Generic names provide a universal reference that isn't tied to specific manufacturers
- Consistency: Generic names remain constant even when brand names may change or vary by region
- Clarity: Using generic terminology reduces confusion when multiple brand names exist for the same medication
Clinical Implications of Generic Name Usage
Generic drug naming in CPT follows established naming conventions developed through the United States Adopted Names (USAN) Program, which has been assigning nonproprietary names to active drug ingredients since the 1960s 1. These names often contain specific syllables (stems) that convey information about:
- Chemical structure of the medication
- Mechanism of action
- Clinical indications
Contrast with Clinical Practice
Interestingly, while CPT uses generic names, clinical practice often differs:
- Physicians frequently refer to drugs by brand names in clinical documentation, with studies showing brand name usage as high as 98% for some common medications 2
- This discrepancy between coding standards and clinical practice can create challenges in medical documentation and billing
- A study of hospital prescribers found that many clinicians couldn't identify the generic names of common drugs when given only the brand name 3
Practical Implications for Coding
When coding laboratory tests that involve drug testing, monitoring, or therapeutic drug assays:
- Always reference the generic drug name in the CPT manual
- Be aware that clinical documentation may use brand names instead
- Maintain reference materials that cross-reference brand and generic names
- Consider that using generic terminology in all aspects of healthcare could reduce errors and costs 4
Common Pitfalls to Avoid
- Searching by brand name: Looking up laboratory tests by brand names in CPT will be unsuccessful
- Confusion with similar-sounding drugs: Generic drug names can be complex and similar-sounding 5
- Outdated terminology: Ensure you're using current generic names as these can occasionally be revised
By consistently using generic drug names in the Pathology/Laboratory section, CPT provides a standardized framework for coding laboratory procedures related to medication testing and monitoring.