What is CPT Medical Coding?
CPT is the language used by providers and payers, which is fundamental to medical care billing and refund procedures.
The current nomenclature of the procedures, most commonly known as CPT, refers to a system of medical codes used to designate procedures and services for physicians, allies, non-physicians, hospitals and laboratories.
Specifically, CPT codes are used to represent governmental and commercial reimbursement processes and services.
In 1966, CPT codes for standardizing health, surgical, and diagnostic services and procedures in hospital and ambulatory conditions were created by the American Medical Association (AMA).
Each CPT code is a recorded treatment or service description that eliminates the subjective assessment of exactly what was given to the patient.
The AMA updates CPT codes every year, releasing new, updated, and deleted codes, together with modifications to CPT coding standards to reflect the changing health care environment—including access to new services and the removal of existing procedures.
The AMA also modifies the CPT nomenclature or medical language to match advances in the area.
While the AMA is the CPT copyright company, it encourages suppliers and organizations that are pleased to make amendments to the code descriptors and descriptors to keep the code set.
Recognition of CPT codes
There are 5 characters for CPT codes.
Most codes are numerical, although some like F, T or U are alpha-fifth.
Examples of examples include
33275 — Removal of permanent pacemaker, right ventricular 3006F — X-ray results documented and studied (CAP)
Single nucleotide multi-faceted polymorphisms, urine, and oral DNA selected for identification testing of specimens 0510T—Removal of sinus tarsi implants 0079U
CPT® Codes Type
Coders assign a code to each service or operation a provider does.
CPT® also contains services and operations codes not specifically mentioned in the CPT® defined code, which is known as unlisted codes.
Due to the broad variety of services and processes, CPT® codes were systematically divided into AMA, beginning with their triple-type categorization.
CPT® Category I — the largest collection of codes that providers usually use to report their services and activities
CPT® Category II — Supplementary monitoring codes for performance management
CPT® Category III – interim codes for developing services and experimental reporting
Navigation Codes Category I
Most CPT® codes are Category I codes.
These represent actual services or methods extensively used and permitted by Food and Drug Administration (FDA).
Category I codes, indicated with five numerical characters, are provided with two exceptions in numerical sequence.
The desired order is divided into resequenced codes.
The AMA clusters share related codes to enable medical coders to have rapid access to connected codes and therefore to assist in selecting the correct code.
A resequenced code is not available when a new code is introduced to a family of codes.
The second exception to the number code sequence comprises evaluation and management (E/M) codes.
As you can see in the category I codes below, whereas E/M codes are initially entered in CPT® code books with the number 9.
The AMA has chosen this rating as I/O services are the medical services most commonly reported.
This structure, along with resequenced codes, is designed for efficiency coding.
The six main components of CPT® Category I are
Services for Assessment and Management (99202 – 99499)
Anesthesia services (01000 – 01999)
Operation (10021 – 69990) – divided into a body or system inside these codes
Radiology services (70010 – 79999)
Pathology and services in laboratories (80047 – 89398)
Medical services and procedures (90281–99607)
Learn about Category II codes
The four-number and letter F Category II codes are extra monitoring and performance assessment codes that providers may give, in addition to category I codes.
Category II codes are not paid unlike Category I codes.
Providers use Category II codes to monitor the information provided by patients, such as whether they use cigarettes, to help them improve health and enhance the results of their patients.
You will find Category II codes directly after category I codes in your CPT® code book.
CPT Code Arrangements
The codes below are arranged
Composite shares (0001F – 0015F)
Patient management (0500F – 0584F)
Patient history (1000F – 1505F)
Test physique (2000F – 2060F)
Diagnostic/screening process or outcomes (3006F – 3776F)
Preventive therapeutic interventions or other interventions (4000F – 4563F)
Additional findings (5005F – 5250F)
Patient safety (6005F – 6150F)
Structural measures (7010F – 7025F)
Non-measurement code listing (9001F – 9007F)
Category III Presentation of Codes
Category III codes are provided in the four numbers and letter T coding manual of Category III.
These are temporary designations that reflect new technology, services and approaches.
Category III may remain temporary classifications that define new services and procedures for up to five years.
If the services and treatments they represent comply with Category I standards – including FDA approval, evidence of the efficient proceeding by many providers – Category I numbers should be awarded once again.
Conversely, it can be deleted if providers do not use category III codes.
The AMA provides semi-annual new or modified Category III codes on its website but publishes annual Category III deletions using the entire set of temporary codes.
CPT® Codes Learning
There is a lot to comprehend for new CPT® coders – regulations, comments, code descriptors, standards, recommendations.
Firstly, as you anticipate, procedural code demands a good grasp of the medical and anatomical language.
One process may be varied, somewhat different and the correct code can be picked for the clinical record and the code description—to grasp what the procedure is, how the Doctor conducted it and which code descriptor captures the highest procedure specificities.
In addition, this understanding of anatomy and medical language must be comprehensive as suppliers might provide therapies requiring CPT® codes in any area of the coding manual.
They are not limited to their expertise.
For example, X-ray codes are listed in radiology, but a prime care coder is required to assign the appropriate X-ray code if the primary care practitioner analyzes the x-ray.
CPT® standards on coding create trust
The AMA offers CPT® coding guidelines which state when and how codes are to be assigned, how providers execute simultaneous activities and other key aspects for compliance coding.
Before trying to assign codes in that classification, the CPT® guidelines in each part, subsection, subdivision, category or subcategory may not be emphasized sufficiently.
Similarly, consider searching for appropriate training and qualifications before accepting the position of creating and reporting CPT® medical claims codes. You can use medical encoding software to help file your medical claims.
This is the ideal method to ensure the accurate coding and optimal reimbursement for your company.
Append CPT® Modifier Codes
CPT® codes need skill in using CPT® modificers.
What is a modification to CPT®?
The modifier has two numbers, two letters, or a number and a letter.
A coder must append a modifier to a CPT® code to describe more often the service or operation carried out.
For example, certain changes show that surgery is done on the right side of the body, on the left or on both sides.
Greater changes imply a doctor has spent additional time and effort performing a therapy or surgery.
You may wonder why the CPT® code does not carry any more modification information.
Simply said, if they contain any code that an encoder can discover in all circumstances, CPT® coding books would be excessively large and cumbersome.
A quick list of modifications expands the particular terms of the services and operations performed.
As with CPT®, CPT® coding changes are generated and maintained annually by the AMA.
These modifications are listed in the CPT® Coders Code Book.
Note, however, that payers might use modifiers differently, thus it is important to examine each payer’s amending criteria.
Note also that certain codes are “free of change,” as specified in the manual by the AMA under the relevant codes.
CPT® linked to other coding sets
As you might know, CPT® is one of four primary code systems.
The extra code sets include
HCPCS Level II — used for reporting procedures, services, supplies, medication and equipment
ICD-10-PCS — used in hospital operations (hospitals)
ICD-10-CM — utilized for reporting diagnostics in or out of patients
Let us support HCPCS Level II codes and how to compare them with CPT® codes.
HCPCS is the common procedural code system for healthcare (HCPCS).
What we truly call HCPCS codes is level II or level II HCPCS codes.
The CPT® code set includes Level I of the Common Procedural Coding System for Healthcare.