Explanation of CPT Coding

Within the healthcare arena, doctors, medical coders, insurance companies and other personne use Current Procedural Terminology (CPT) to identify patient information such as: their symptoms, diagnoses, diseases, injuries, treatments and medical procedures they've received. CPT codes also inform insurance companies of the services rendered to the insured so healthcare practitioners can be reimbursed.

History

• The American Medical Association developed CPT coding in 1966 and has since put forth a yearly publication through its Department of CPT Editorial Research and Development, which provides staff support to the process of adding, modifying and deleting CPT codes.

Features

• CPT codes are broken into three distinct categories: CPT I, CPT II and CPT III.

Types

• As noted by the College of American Pathologists, "CPT I is a five-digit code with definition--used to report service/procedures; CPT II are optional codes used to document and collect quality data--format four digits and a letter; and CPT III is made of the temporary code used to track new technology--format four digits and a letter."

Function

• The CPT Manual is used to determine the correct code and is divided into various sections, including: Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine. The Manual also contains: section headings, subsections, categories, subcategories, guidelines, symbols, colons & semicolon modifiers, appendices, indices and examples--all so the user can identify the precise code.

Identification

• For example, if you were looking for a surgery code (10000-69999), you would go to that section heading, and then look for the correct subheading to identify what type of procedure was done to what part of the body. If it was the Integumentary System (10040-19499) and the procedure was an excision of a benign lesion (11400-11471), you would then need to specify where the incision was made and how big it was.